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The Physiological Rationale for Incorporating Pulsatility in Continuous-Flow Left Ventricular Assist Devices
Liza Grosman-Rimon1,2, Filio Billia3, Jeremy Kobulnik3,4
1From the Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Institute, University Health Network, University of Toronto, Toronto, Canada.
Cardiology in Review
|April 3, 2018
Summary
Continuous-flow left ventricular assist devices (CF-LVADs) improve heart failure survival but lack pulsatility, potentially causing adverse events. This review explores adding pulsatility to CF-LVADs to enhance patient treatment outcomes.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Heart Failure Management
Background:
- Left ventricular assist devices (LVADs) have significantly improved survival for end-stage heart failure patients.
- Continuous-flow (CF) LVADs are the predominant type, necessitating adaptation to continuous blood flow physiology.
- The absence of pulsatility in CF-LVADs, while offering mechanical support benefits, may contribute to adverse events.
Purpose of the Study:
- To evaluate the potential benefits of incorporating pulsatility into current LVAD technology.
- To explore whether pulsatile LVADs can enhance patient outcomes while retaining CF-LVAD advantages.
- To inform the development of next-generation LVADs for optimized heart failure treatment.
Main Methods:
- Review of existing literature on continuous-flow LVADs and pulsatility in mechanical circulatory support.
- Discussion of physiological consequences of non-pulsatile blood flow.
- Analysis of potential clinical benefits and challenges of integrating pulsatility into LVAD design.
Main Results:
- Continuous-flow LVADs offer survival benefits but their non-pulsatile nature presents potential risks.
- The clinical impact of lacking pulsatility in long-term LVAD support remains incompletely understood.
- Incorporating pulsatility may offer advantages, but requires careful consideration alongside CF-LVAD benefits.
Conclusions:
- The necessity of pulsatility in future LVADs is an open question requiring further investigation.
- Balancing the advantages of continuous flow with the potential benefits of pulsatility is key for advancing LVAD therapy.
- Future device evolution should consider pulsatility to potentially maximize treatment efficacy for heart failure patients.
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