Next generation long-term mechanical circulatory support systems: are pulsatile pumps extinct? Challenges, goals, and...

The therapeutic value of mechanically assisted circulation in the management of end-stage congestive heart failure has been shown. However, the ideal mechanical circulatory support device has not been introduced, especially for long-term or permanent use. Such a device should be durable, completely implantable, autonomous, small in size, and easy to use; it should provide a physiologic perfusion pattern. Current trends have favored non-pulsatile or continuous-flow devices over the older pulsatile devices. There has been no significant innovation in pulsatile devices for over 10 years. There is an ongoing debate about the physiologic impact of non-pulsatile flow. We explore the physiologic impact, biocompatibility issues, challenges in energy management, mechanical efficiency, and implantable power sources that exist in developing new classes of pulsatile devices for long-term mechanical circulatory support.