title: Physiologic and hematologic concerns of rotary blood pumps: what needs to be improved?
abstract: Over the past few decades, advances in ventricular assist device (VAD) technology have provided a promising therapeutic strategy to treat heart failure patients. Despite the improved performance and encouraging clinical outcomes of the new generation of VADs based on rotary blood pumps (RBPs), their physiologic and hematologic effects are controversial. Currently, clinically available RBPs run at constant speed, which results in limited control over cardiac workload and introduces blood flow with reduced pulsatility into the circulation. In this review, we first provide an update on the new challenges of mechanical circulatory support using rotary pumps including blood trauma, increased non-surgical bleeding rate, limited cardiac unloading, vascular malformations, end-organ function, and aortic valve insufficiency. Since the non-physiologic flow characteristic of these devices is one of the main subjects of scientific debate in the literature, we next emphasize the latest research regarding the development of a pulsatile RBP. Finally, we offer an outlook for future research in the field.
authors.affiliation: Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland, pirbodaghi@artorg.unibe.ch.
authors.forename: Tohid
authors.initials: T
authors.lastname: Pirbodaghi
authors.forename: Siavash
authors.initials: S
authors.lastname: Asgari
authors.forename: Chris
authors.initials: C
authors.lastname: Cotter
authors.forename: Kevin
authors.initials: K
authors.lastname: Bourque
mesh_terms: D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans
references.citation: J Thorac Cardiovasc Surg. 2007 Jan;133(1):2-6
references.pmid: 17198773
references.citation: ASAIO J. 2010 Sep-Oct;56(5):403-9
references.pmid: 20616704
references.citation: Circ Heart Fail. 2010 Nov;3(6):675-81
references.pmid: 20739614
references.citation: Circulation. 2007 Feb 20;115(7):896-908
references.pmid: 17283259
references.citation: J Card Surg. 2010 Jul;25(4):455-61
references.pmid: 20202033
references.citation: Ann Biomed Eng. 2010 Apr;38(4):1442-50
references.pmid: 20135353
references.citation: Surgery. 1955 Apr;37(4):663-82
references.pmid: 14373281
references.citation: JAMA. 1965 Feb 22;191:657-60
references.pmid: 14242425
references.citation: ASAIO J. 2005 Mar-Apr;51(2):139-43
references.pmid: 15839437
references.citation: Artif Organs. 1996 Feb;20(2):139-42
references.pmid: 8712958
references.citation: Ann Thorac Surg. 2000 Oct;70(4):1270-4
references.pmid: 11081884
references.citation: N Engl J Med. 1990 Jul 5;323(1):27-36
references.pmid: 2113184
references.citation: Eur J Cardiothorac Surg. 2013 Feb;43(2):383-8
references.pmid: 22689185
references.citation: Thromb Haemost. 1985 Aug 30;54(2):381-6
references.pmid: 2934855
references.citation: N Engl J Med. 2007 Aug 30;357(9):885-96
references.pmid: 17761592
references.citation: J Card Surg. 2010 Jul;25(4):490-4
references.pmid: 20642766
references.citation: Artif Organs. 1999 Aug;23(8):722-6
references.pmid: 10463496
references.citation: Ann Thorac Surg. 2010 Oct;90(4):1263-9; discussion 1269
references.pmid: 20868825
references.citation: Circ Heart Fail. 2010 Nov;3(6):668-74
references.pmid: 20739615
references.citation: Eur Heart J. 2011 May;32(9):1148-60
references.pmid: 20929978
references.citation: Artif Organs. 2011 Aug;35(8):825-32
references.pmid: 21793862
references.citation: J Heart Lung Transplant. 2010 Oct;29(10):1172-6
references.pmid: 20619680
references.citation: J Heart Lung Transplant. 2007 Jun;26(6):572-8
references.pmid: 17543779
references.citation: J Cardiovasc Transl Res. 2010 Dec;3(6):618-24
references.pmid: 20835786
references.citation: Arterioscler Thromb Vasc Biol. 2006 Aug;26(8):1729-37
references.pmid: 16741150
references.citation: Circulation. 1998 Jun 16;97(23):2316-22
references.pmid: 9639375
references.citation: J Thorac Cardiovasc Surg. 2009 Jan;137(1):208-15
references.pmid: 19154927
references.citation: J Am Coll Cardiol. 2010 Oct 5;56(15):1207-13
references.pmid: 20598466
references.citation: J Heart Lung Transplant. 2009 Apr;28(4):352-9
references.pmid: 19332262
references.citation: J Thorac Cardiovasc Surg. 2007 Feb;133(2):575-6
references.pmid: 17258608
references.citation: J Card Surg. 2010 Jul;25(4):484-9
references.pmid: 20642765
references.citation: N Engl J Med. 2003 Jul 24;349(4):343-9
references.pmid: 12878741
references.citation: J Cardiovasc Transl Res. 2013 Apr;6(2):294
references.pmid: 22903914
references.citation: J Heart Lung Transplant. 2008 Dec;27(12):1269-74
references.pmid: 19059105
references.citation: Eur J Cardiothorac Surg. 2010 Feb;37(2):350-6
references.pmid: 19589689
references.citation: Circulation. 2001 Sep 4;104(10):1147-52
references.pmid: 11535571
references.citation: ASAIO J. 1996 Sep-Oct;42(5):M620-4
references.pmid: 8944955
references.citation: J Heart Lung Transplant. 2011 Aug;30(8):849-53
references.pmid: 21530318
references.citation: J Thorac Cardiovasc Surg. 2012 Oct;144(4):970-7
references.pmid: 22418246
references.citation: J Heart Lung Transplant. 2006 Apr;25(4):391-4
references.pmid: 16563966
references.citation: J Heart Lung Transplant. 1997 Jul;16(7):765-73
references.pmid: 9257259
references.citation: Artif Organs. 2006 Aug;30(8):638-42
references.pmid: 16911321
references.citation: J Heart Lung Transplant. 2012 Jul;31(7):715-8
references.pmid: 22425231
references.citation: ASAIO J. 2003 Jan-Feb;49(1):103-7
references.pmid: 12558315
references.citation: J Heart Lung Transplant. 2008 Oct;27(10):1096-101
references.pmid: 18926400
references.citation: J Heart Lung Transplant. 2010 Dec;29(12):1321-9
references.pmid: 20674397
references.citation: Circulation. 1995 Jun 1;91(11):2717-20
references.pmid: 7758175
references.citation: J Am Coll Cardiol. 2009 Jul 21;54(4):312-21
references.pmid: 19608028
references.citation: Interact Cardiovasc Thorac Surg. 2010 Aug;11(2):133-7
references.pmid: 20472650
references.citation: J Heart Lung Transplant. 2005 Jan;24(1):105-9
references.pmid: 15653390
references.citation: Artif Organs. 2000 Jun;24(6):405-11
references.pmid: 10886056
references.citation: Curr Heart Fail Rep. 2011 Jun;8(2):91-8
references.pmid: 21336538
references.citation: J Thorac Cardiovasc Surg. 2010 Nov;140(5):1181-8
references.pmid: 20546799
references.citation: J Artif Organs. 2011 Sep;14(3):185-91
references.pmid: 21626099
references.citation: Circulation. 2012 Jun 12;125(23):2844-53
references.pmid: 22586279
references.citation: Ann Biomed Eng. 1994 Sep-Oct;22(5):445-55
references.pmid: 7825747
references.citation: J Biomech. 2001 Oct;34(10):1361-4
references.pmid: 11522317
references.citation: Circulation. 2009 Dec 8;120(23):2352-7
references.pmid: 19933938
references.citation: J Heart Lung Transplant. 2007 Aug;26(8):815-8
references.pmid: 17692785
references.citation: Artif Organs. 2010 Sep;34(9):703-6
references.pmid: 20883388
references.citation: N Engl J Med. 2006 Nov 2;355(18):1873-84
references.pmid: 17079761
references.citation: Circulation. 1998 Aug 18;98(7):656-62
references.pmid: 9715858
references.citation: Circulation. 2012 Jun 19;125(24):3038-47
references.pmid: 22711669
references.citation: Eur Heart J. 2011 Aug;32(16):2034-41
references.pmid: 21186238
references.citation: Ann Thorac Surg. 2002 Oct;74(4):1080-5
references.pmid: 12400749
references.citation: Platelets. 2003 May;14(3):143-9
references.pmid: 12850838
references.citation: J Heart Lung Transplant. 1996 Aug;15(8):840-2
references.pmid: 8998278