Does pulsatility matter in the era of continuous-flow blood pumps?

Despite significant improved survival with continuous flow left ventricular assist devices (LVADs), complications related to aortic valve insufficiency, gastrointestinal bleeding, stroke, pump thrombosis, and hemolysis have dampened the long term success of these pumps. Evolution has favored a pulsatile heart pump to be able to deliver the maximum flow at different levels of systemic vascular resistance, confer kinetic energy to the flow of blood past areas of stenosis and generate low shear stress on blood elements. In this perspective, we suggest that lack of pulsatility may be one factor that has limited the success of continuous flow LVADs and suggest that research needs to focus on methods to generate pulsatility either by the native heart or by various speed modulation algorithms.

[1]  H Harasaki,et al.  Physiopathological studies of nonpulsatile blood flow in chronic models. , 1983, Transactions - American Society for Artificial Internal Organs.

[2]  D B Olsen,et al.  Pulsatile operation of a centrifugal ventricular assist device with magnetic bearings. , 1996, ASAIO journal.

[3]  Yoshifumi Naka,et al.  Results of the post-U.S. Food and Drug Administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). , 2011, Journal of the American College of Cardiology.

[4]  J. Morgan,et al.  Significance of postoperative acute renal failure after continuous-flow left ventricular assist device implantation. , 2013, The Annals of thoracic surgery.

[5]  Dong Chen,et al.  Acquired von Willebrand syndrome in continuous-flow ventricular assist device recipients. , 2010, The Annals of thoracic surgery.

[6]  Francis D. Pagani,et al.  The Development of Aortic Insufficiency in Left Ventricular Assist Device-Supported Patients , 2010, Circulation. Heart failure.

[7]  Jeffrey R. Gohean,et al.  Improved left ventricular unloading and circulatory support with synchronized pulsatile left ventricular assistance compared with continuous-flow left ventricular assistance in an acute porcine left ventricular failure model. , 2010, The Journal of thoracic and cardiovascular surgery.

[8]  Stijn Vandenberghe,et al.  Pulsatile control of rotary blood pumps: Does the modulation waveform matter? , 2012, The Journal of thoracic and cardiovascular surgery.

[9]  Pascal Verdonck,et al.  Unloading effect of a rotary blood pump assessed by mathematical modeling. , 2003, Artificial organs.

[10]  A. Ündar,et al.  Effects of the Pulsatile Flow Settings on Pulsatile Waveforms and Hemodynamic Energy in a PediVAS™ Centrifugal Pump , 2009, ASAIO journal.

[11]  Guruprasad A Giridharan,et al.  Rotary Pumps and Diminished Pulsatility: Do We Need a Pulse? , 2013, ASAIO journal.

[12]  K. Muthiah,et al.  Thrombolysis for suspected intrapump thrombosis in patients with continuous flow centrifugal left ventricular assist device. , 2013, Artificial organs.

[13]  Hamid Nayeb-Hashemi,et al.  Effect of Pulsatile Blood Flow on Thrombosis Potential With a Step Wall Transition , 2010, ASAIO journal.

[14]  W. Schlesinger,et al.  Ceanothus megacarpus chaparral: A synthesis of ecosystem processes during development and annual growth , 2008, The Botanical Review.

[15]  T. Myers,et al.  Gastrointestinal bleeding from arteriovenous malformations in patients supported by the Jarvik 2000 axial-flow left ventricular assist device. , 2005, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[16]  Stijn Vandenberghe,et al.  Asymmetric speed modulation of a rotary blood pump affects ventricular unloading. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  Daniel Tamez,et al.  Design concepts and principle of operation of the HeartWare ventricular assist system. , 2010, ASAIO journal.

[18]  A C Guyton,et al.  The relationship of cardiac output and arterial pressure control. , 1981, Circulation.

[19]  Y Sezai,et al.  Major organ function under mechanical support: comparative studies of pulsatile and nonpulsatile circulation. , 1999, Artificial organs.

[20]  P. Lawford,et al.  Numerical Modeling of Hemodynamics with Pulsatile Impeller Pump Support , 2010, Annals of Biomedical Engineering.

[21]  William A. Smith,et al.  Reduced pulsatility induces periarteritis in kidney: role of the local renin-angiotensin system. , 2008, The Journal of thoracic and cardiovascular surgery.

[22]  John L. Myers,et al.  Precise Quantification of Pressure Flow Waveforms of a Pulsatile Ventricular Assist Device , 2005, ASAIO journal.

[23]  A Undar,et al.  Defining pulsatile perfusion: quantification in terms of energy equivalent pressure. , 1999, Artificial organs.

[24]  C. Bhamidipati,et al.  Early thrombus in a HeartMate II left ventricular assist device: a potential cause of hemolysis and diagnostic dilemma. , 2010, The Journal of thoracic and cardiovascular surgery.

[25]  M. Ono,et al.  Change of coronary flow by continuous-flow left ventricular assist device with cardiac beat synchronizing system (native heart load control system) in acute ischemic heart failure model. , 2013, Circulation journal : official journal of the Japanese Circulation Society.

[26]  M. S. Halbreiner,et al.  Myocardial recovery: a focus on the impact of left ventricular assist devices , 2014, Expert review of cardiovascular therapy.

[27]  V. Mehta,et al.  Diagnosis of hemolysis and device thrombosis with lactate dehydrogenase during left ventricular assist device support. , 2014, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[28]  J. Haga,et al.  Molecular basis of the effects of shear stress on vascular endothelial cells. , 2005, Journal of biomechanics.

[29]  Steven C. Koenig,et al.  Defining pulsatility during continuous-flow ventricular assist device support. , 2013, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[30]  R. Hetzer,et al.  Arterial wall histology in chronic pulsatile-flow and continuous-flow device circulatory support. , 2012, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[31]  Ranjit John,et al.  Bleeding and Thrombosis in Patients With Continuous-Flow Ventricular Assist Devices , 2012, Circulation.

[32]  Steven C. Koenig,et al.  Flow Modulation Algorithms for Continuous Flow Left Ventricular Assist Devices to Increase Vascular Pulsatility: A Computer Simulation Study , 2011 .

[33]  Y Taenaka,et al.  Effects of long-term nonpulsatile left heart bypass on the mechanical properties of the aortic wall. , 1999, ASAIO journal.

[34]  Aly El-Banayosy,et al.  Development of Aortic Insufficiency in Patients Supported With Continuous Flow Left Ventricular Assist Devices , 2012, ASAIO journal.

[35]  Eisuke Tatsumi,et al.  Change in myocardial oxygen consumption employing continuous-flow LVAD with cardiac beat synchronizing system, in acute ischemic heart failure models , 2013, Journal of Artificial Organs.

[36]  H. Harasaki,et al.  Chronic nonpulsatile blood flow. I. Cerebral autoregulation in chronic nonpulsatile biventricular bypass: carotid blood flow response to hypercapnia. , 1994, The Journal of thoracic and cardiovascular surgery.

[37]  M. Rudnick,et al.  Renal failure in patients with left ventricular assist devices. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[38]  Yoshiyuki Sowa,et al.  Bacterial flagellar motor , 2004, Quarterly Reviews of Biophysics.

[39]  Eisuke Tatsumi,et al.  Development of a novel drive mode to prevent aortic insufficiency during continuous-flow LVAD support by synchronizing rotational speed with heartbeat , 2013, Journal of Artificial Organs.

[40]  Marcel C M Rutten,et al.  A mathematical model to evaluate control strategies for mechanical circulatory support. , 2009, Artificial organs.

[41]  Eisuke Tatsumi,et al.  Alteration of LV end-diastolic volume by controlling the power of the continuous-flow LVAD, so it is synchronized with cardiac beat: development of a native heart load control system (NHLCS) , 2012, Journal of Artificial Organs.

[42]  Robert L Kormos,et al.  Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. , 2013, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[43]  Priya Sharma,et al.  The development of aortic insufficiency in continuous-flow left ventricular assist device-supported patients. , 2013, The Annals of thoracic surgery.

[44]  K. Affeld,et al.  Assisted Circulation 2 , 1984, Springer Berlin Heidelberg.

[45]  R B Shepard,et al.  Energy equivalent pressure. , 1966, Archives of surgery.

[46]  Patrick Segers,et al.  Hemodynamic Modes of Ventricular Assist with a Rotary Blood Pump: Continuous, Pulsatile, and Failure , 2005, ASAIO journal.

[47]  Guruprasad A Giridharan,et al.  Flow Modulation Algorithms for Intra-Aortic Rotary Blood Pumps to Minimize Coronary Steal , 2013, ASAIO journal.

[48]  K. Fukamachi,et al.  Periarteritis in lung from a continuous-flow right ventricular assist device: role of the local Renin-Angiotensin system. , 2013, The Annals of thoracic surgery.