This study investigated the accuracy of the HeartWare HVAD flow estimator for left ventricular assist device (LVAD) support and biventricular assist device (BiVAD) support for modes of reduced speed (BiVAD-RS) and banded outflow (BiVAD-B). The HVAD flow estimator was evaluated in a mock circulatory loop under changes in systemic and pulmonary vascular resistance, heart rate, central venous pressure, and simulated hematocrit (correlated to viscosity). A difference was found between mean estimated and mean measured flow for LVAD (0.1 ± 0.3 L/min), BiVAD-RS (-0.1 ± 0.2 L/min), and BiVAD-B (0 ± 0.2 L/min). Analysis of the flow waveform pulsatility showed good correlation for LVAD (r2 = 0.98) with a modest spread in error (0.7 ± 0.1 L/min), while BiVAD-RS and BiVAD-B showed similar spread in error (0.7 ± 0.3 and 0.7 ± 0.2 L/min, respectively), with much lower correlation (r2 = 0.85 and r2 = 0.60, respectively). This study demonstrated that the mean flow error of the HVAD flow estimator is similar when the device is used in LVAD, BiVAD-RS, or BiVAD-B configuration. However, the instantaneous flow waveform should be interpreted with caution, particularly in the cases of BiVAD support.
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