title: Does pulsatility matter in the era of continuous-flow blood pumps?
abstract: 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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: moazamn@ccf.org.
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
authors.affiliation: Department of Cardiac Surgery, Sharp Memorial Hospital, San Diego, California.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Dembitsky
authors.affiliation: Department of Cardiac Surgery, Sharp Memorial Hospital, San Diego, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Adamson
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Steffen
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Soltesz
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
mesh_terms: D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D011673:Pulsatile Flow / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology*
keywords: LVAD; LVAD complications; continuous flow; mechanical circulatory support; pulsatility