title: Axial and centrifugal continuous-flow rotary pumps: a translation from pump mechanics to clinical practice.
abstract: The recent success of continuous-flow circulatory support devices has led to the growing acceptance of these devices as a viable therapeutic option for end-stage heart failure patients who are not responsive to current pharmacologic and electrophysiologic therapies. This article defines and clarifies the major classification of these pumps as axial or centrifugal continuous-flow devices by discussing the difference in their inherent mechanics and describing how these features translate clinically to pump selection and patient management issues. Axial vs centrifugal pump and bearing design, theory of operation, hydrodynamic performance, and current vs flow relationships are discussed. A review of axial vs centrifugal physiology, pre-load and after-load sensitivity, flow pulsatility, and issues related to automatic physiologic control and suction prevention algorithms is offered. Reliability and biocompatibility of the two types of pumps are reviewed from the perspectives of mechanical wear, implant life, hemolysis, and pump deposition. Finally, a glimpse into the future of continuous-flow technologies is presented.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Kaufman Center for Heart Failure, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195, USA. moazamn@ccf.org
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
authors.forename: Mariko
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hoercher
authors.forename: Alex
authors.initials: A
authors.lastname: Massiello
authors.forename: Sangjin
authors.initials: S
authors.lastname: Lee
authors.forename: David J
authors.initials: DJ
authors.lastname: Horvath
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D001696:Biomechanical Phenomena; D006353:Heart-Assist Devices; D006461:Hemolysis; D006801:Humans; D057446:Hydrodynamics; D055595:Mechanical Phenomena; D011474:Prosthesis Design; D018581:Technology Transfer