title: The Physiology of Continuous-Flow Left Ventricular Assist Devices.
abstract: The use of left ventricular assist devices (LVADs) has increased significantly over the past few years, in part because heart transplant activity has plateaued, but also because of the improving clinical outcomes with contemporary continuous-flow LVAD. As such, there is now a growing population of patients with continuous-flow LVADs. Management of these patients is complicated by the altered circulatory physiology, because continuous-flow LVADs provide a parallel circulation from the heart to the aorta, which interacts with the native left heart (systemic) circulation with consequent effects on the right heart circulation. In addition, the displayed pump parameters can mislead the unwary clinician. An understanding of LVAD physiology can guide clinicians in the management of patients with LVADs. This review describes the basic design of axial and centrifugal continuous-flow LVADs, the functional anatomy and physiology of continuous-flow LVADs, and the interaction between the heart and the LVAD. leading to a discussion about the interpretation of the pump parameters in clinical practice.
authors.affiliation: University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. Electronic address: sern.lim@uhb.nhs.uk.
authors.forename: Hoong Sern
authors.initials: HS
authors.lastname: Lim
authors.affiliation: University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Howell
authors.affiliation: University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Aaron
authors.initials: A
authors.lastname: Ranasinghe
mesh_terms: D004869:Equipment Safety; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011673:Pulsatile Flow / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D006113:United Kingdom
keywords: Heart failure; physiology; ventricular assist device