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Updated: Apr 19, 2026
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to
Allen Cheng1, Christine A Williamitis1, Mark S Slaughter1
1Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
Insights
Continuous-flow left ventricular assist devices (CFVAD) offer advantages but may cause complications due to lack of pulsatility. Incorporating pulsatility into CFVADs could improve long-term outcomes and left ventricular recovery.
Area of Science:
- Cardiovascular Engineering
- Biomedical Devices
- Heart Failure Management
Background:
- Continuous-flow left ventricular assist devices (CFVAD) are standard for end-stage heart failure.
- CFVADs offer improved reliability over pulsatile-flow left ventricular assist devices (PFVADs).
- CFVADs are linked to complications potentially caused by reduced arterial pulsatility.
Purpose of the Study:
- To compare outcomes between CFVADs and PFVADs.
- To evaluate the necessity of arterial pulsatility in mechanical circulatory support.
Main Methods:
- Comparative review of CFVAD and PFVAD outcomes.
- Analysis of the role of arterial pulsatility in VAD therapy.
Main Results:
- CFVADs provide benefits like smaller size, enhanced reliability, and survival rates.
- Long-term CFVAD support may lead to complications, reduced left ventricular recovery, and issues with aortic valve gradients and arterial compliance.
- Pulsatile support from PFVADs or CFVADs with pulsatility algorithms may be crucial for extended support.
Conclusions:
- Future VADs should integrate pulsatility while retaining CFVAD benefits.
- Further research is needed on physiological responses to varying pulsatility levels in VADs.
Background:
Continuous-flow left ventricular assist devices (CFVAD) are currently the most widely used type of mechanical circulatory support as bridge-to-transplant and destination therapy for end-stage congestive heart failure (HF). Compared to the first generation pulsatile-flow left ventricular assist devices (PFVADs), CFVADs have demonstrated improved reliability and durability. However, CFVADs have also been associated with certain complications thought to be linked with decreased arterial pulsatility. Previous studies comparing CFVADs and PFVADs have presented conflicting results. It is important to understand the outcome differences between CFVAD and PFVAD in order to further advance the current VAD technology.
Methods:
In this review, we compared the outcomes of CFVADs and PFVADs and examined the need for arterial pulsatility for the future generation of mechanical circulatory support.
Results:
CVADs offer advantages of smaller size, increased reliability and durability, and subsequent improvements in survival. However, with the increasing duration of long-term support, it appears that CFVADs may have specific complications and a lower rate of left ventricular recovery associated with diminished pulsatility, increased pressure gradients on the aortic valve and decreased compliance in smaller arterial vessels. PFVAD support or pulsatility control algorithms in CFVADs could be beneficial and potentially necessary for long term support.
Conclusions:
Given the relative advantages and disadvantages of CFVADs and PFVADs, the ultimate solution may lie in incorporating pulsatility into current and emerging CFVADs whilst retaining their existing benefits. Future studies examining physiologic responses, end-organ function and LV remodeling at varying degrees of pulsatility and device support levels are needed.
