Physiologic effects of continuous-flow left ventricular assist devices

详细信息    查看全文

• 作者：Aaron H. Healy ; MD^a ; Stephen H. McKellar ; MD ; MSc^a ; Stavros G. Drakos ; MD ; PhD^b ; Antigoni Koliopoulou ; MD^a ; Josef Stehlik ; MD ; MPH^b ; Craig H. Selzman ; MD^a ; ^{craig.selzman@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cardiac surgery ; Heart failure ; Left ventricular assist device ; Mechanical circulatory support ; Physiology
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：15 May 2016
• 年：2016
• 卷：202
• 期：2
• 页码：363-371
• 全文大小：726 K

文摘

Within the past 10 years, continuous-flow left ventricular assist devices (LVADs) have replaced pulsatile-flow LVADs as the standard of care for both destination therapy and bridging patients to heart transplantation. Despite the rapid clinical adoption of continuous-flow LVADs, an understanding of the effects of continuous-flow physiology, as opposed to more natural pulsatile-flow physiology, is still evolving.

Materials and methods

A thorough review of the relevant scientific literature regarding the physiological and clinical effects of continuous-flow physiology was performed. These effects were analyzed on an organ system basis and include an evaluation of the cardiovascular, respiratory, hematologic, gastrointestinal, renal, hepatic, neurologic, immunologic, and endocrine systems.

Results

Continuous-flow physiology is, generally speaking, well tolerated over the long term. However, several changes are manifest at the organ system level. Although many of these changes are without appreciable clinical significance, other changes, such as an increased rate of gastrointestinal bleeding, appear to be associated with continuous-flow physiology.

Conclusions

Continuous-flow LVADs confer a significant advantage over their pulsatile-flow counterparts with regard to size and durability. From a physiological standpoint, continuous-flow physiology has limited clinical effects at the organ system level. Although improved over previous generations, challenges with this technology remain. Approaching these problems with a combination of clinical and engineering solutions may be needed to achieve continued progression in the field of durable mechanical circulatory support.