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An optimal interaction between the Ventricular Assist Device and assisted heart will depend on precise timing of maximal flow generated by the device in relation to the ejection phase of the assisted heart. Such precise timing can be derived from the pressure-volume plane. The logic holds that a heart treated with a pump should be analyzed as a pump.

The Pressure-Volume (PV) catheter has proven useful during the evaluation of various novel surgical procedures such as Surgical Ventricular Restoration (SVR) , Cardiomyoplasty and the placement of LVADs.

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1	LV pressure and volume were continuously assessed by a pressure-conductance catheter at 4 different support levels of the Impella, from 0 L/min at baseline to 2.5 L/min at maximal support. Remmelink et al. Effects of mechanical left ventricular unloading by Impella on left ventricular dynamics in high-risk and primary percutaneous coronary intervention patients. Catheter Cardiovasc Interv. 2010 Feb 1;75(2):187-94.
2	The effect of biventricular pacing on cardiac function after weaning from cardiopulmonary bypass in patients with reduced left ventricular function: a pressure-volume loop analysis. Hanke et al. J Thorac Cardiovasc Surg. 2009 Jul;138(1):148-56. Epub 2009 Apr 8.
3	Leycom’s pressure-volume analysis technique was used to evaluate in real-time heart failure patients during cardiac surgery. Ten Brinke EA, et al. Haemodynamics and left ventricular function in heart failure patients: comparison of awake versus intra-operative conditions. Eur J Heart Fail. 2008;10:467-74.
4	First and foremost, this study emphasizes the importance of using the pressure-volume approach for understanding the impact of SVR on ventricular pump function. Burkhoff D, Wechsler AS. Surgical ventricular remodeling: a balancing act on systolic and diastolic properties. J Thorac Cardiovasc Surg. 2006 Sep;132(3):610-20.
5	The PV analysis showed the occurrence of an acute volume increase in the majority of patients immediately after Impella insertion that tended to persist even at maximal pump speed. Valgimigli et al. Use of Impella Recover(R) LP 2.5 left ventricular assist device during high-risk percutaneous coronary interventions; clinical, haemodynamic and biochemical findings. EuroIntervention. 2006 May;2(1):91-100.
6	Surgical LV restoration achieves normalization of LV volumes and improves systolic function and mechanical efficiency by reducing LV wall stress and mechanical dyssynchrony as demonstrated by CD Leycom’s P-V analysis technique. Tulner SA, et al. Surgical ventricular restoration in patients with ischemic dilated therapy: evaluation of systolic and diastolic ventricular function , wall stress, dyssynchrony and mechanical efficiency by pressure-volume loops. J Thorac Cardiovasc Surg. 2006;132:459-63.
7	The effects on global cardiac output were determined by thermodilution (TD) and LV pressure-volume loops obtained by conductance catheter. Valgimigli et al. Left ventricular unloading and concomitant total cardiac output increase by the use of percutaneous Impella Recover LP 2.5 assist device during high-risk coronary intervention. Catheter Cardiovasc Interv. 2005 Jun;65(2):263-7.
8	The applied conductance catheter technique allows intra-operative evaluation of the left ventricular mechanical and energy efficiency, which might be of value for long-term outcome of left ventricular restoration. Schreuder JJ, et al. Acute decrease of left ventricular mechanical dyssynchrony and improvement of contractile state and energy efficiency after left ventricular restoration. J Thorac Cardiovasc Surg 2005;129:138-145
9	Left ventricular performance during IABP is causally related to changes in LV afterload, and the timing of these changes in relation to contraction or relaxation phases, to LV mechanical dyssynchrony and to contractile state. Schreuder JJ, et al. Acute effects of intra-aortic counterpulsation timing on left ventricular performance in patients with low ejection fraction. Annals of Thoracic Surg 2005;79:1017-1022.
10	Diastolic unloading and improved LV pump efficiency early after repair of the insufficient mitral valve Gunziger R, et al. Diastolic unloading and improved LV pump efficiency early after repair of the insufficient mitral valve. Thorac Cardiov Surg 2005;53:9-15.
11	Pressure-volume loops in patients with aortic stenosis. Dekker AL, Barenbrug PJ, van der Veen FH, Roekaerts P, Mochtar B, Maessen JG.J. Pressure-volume loops in patients with aortic stenosis. Heart Valve Dis. 2003 May;12(3):325-32.

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