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Creating adequate pulsatility with a continuous flow left ventricular assist device: just do it!

Snehal R Patel1, Ulrich P Jorde

  • 1Division of Cardiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.

Current Opinion in Cardiology
|April 8, 2016
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Summary

Continuous flow left ventricular assist devices (LVADs) create low pulsatile flow, linked to adverse events like hemolysis and bleeding. Future LVADs may mitigate risks by incorporating optimized pulsatility.

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Heart Failure Treatment

Background:

  • Continuous flow left ventricular assist devices (LVADs) are crucial for advanced heart failure.
  • Adverse events associated with LVADs necessitate a deeper understanding of their underlying physiology.
  • The role of pulsatility in LVAD-related complications requires thorough investigation.

Purpose of the Study:

  • To review the current literature linking a lack of pulsatility to adverse events in continuous flow LVADs.
  • To explore the physiological consequences of altered pulsatility in patients with LVADs.
  • To inform the development of next-generation LVADs with improved safety profiles.

Main Methods:

  • Literature review of studies investigating pulsatility in continuous flow LVADs.
  • Analysis of physiological alterations in vascular, baroreceptor, and sympathetic nervous system function.
  • Correlation of clinical events with the degree of pulsatility in LVAD support.

Main Results:

  • Continuous flow LVAD physiology exists on a spectrum of low pulsatility, not true nonpulsatility.
  • Alterations in vascular function and structure are associated with the degree of pulsatility.
  • Clinical events including impaired ventricular unloading, hemolysis, aortic insufficiency, and bleeding are linked to LVAD pulsatility.

Conclusions:

  • Low pulsatility in current continuous flow LVADs contributes to several adverse effects.
  • Understanding pulsatility as a continuous variable is key to mitigating LVAD complications.
  • Future LVAD designs should consider incorporating optimized pulsatility to enhance patient outcomes.