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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
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Physiology of Continuous-Flow Left Ventricular Assist Device Therapy
Andrew N Rosenbaum1,2, James F Antaki3, Atta Behfar1,2,4
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Comprehensive Physiology
|December 29, 2021
Summary
Continuous-flow left ventricular assist devices (CF-LVADs) improve heart failure but require understanding their interaction with the body. Optimizing CF-LVADs involves managing preload, afterload, and potential complications like hemolysis and right ventricular dysfunction.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Medical Devices
Background:
- Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used for end-stage heart failure.
- Understanding the interaction between CF-LVADs and the native circulation is crucial for effective patient management.
Purpose of the Study:
- To review the physiologic interactions between continuous-flow left ventricular assist devices and the native circulation.
- To discuss the impact of device characteristics and patient factors on mechanical support.
- To highlight the benefits and challenges associated with CF-LVAD therapy.
Main Methods:
- Analysis of pressure-flow (H-Q) curves to predict device-circulatory interactions.
- Evaluation of the effects of preload and afterload on device performance.
- Review of existing literature on CF-LVAD physiology and complications.
Main Results:
- CF-LVADs can be optimized using principles similar to native heart management, but valvular disease, especially aortic regurgitation, can impact support adequacy.
- Therapeutic benefits include enhanced perfusion and reduced pulmonary hypertension, yet challenges arise from right ventricular dysfunction and septal interactions.
- Lack of pulsatile flow may affect end-organ function, and rheological effects like shear stress can lead to thrombotic and hemorrhagic complications.
Conclusions:
- Optimizing CF-LVAD therapy requires a comprehensive understanding of device-circulatory dynamics.
- Addressing negative interactions, such as right ventricular strain and non-pulsatile flow effects, is essential for improving patient outcomes.
- Further research into novel solutions for device-circulatory interactions is needed to mitigate adverse events.
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