Physiologic and Pathologic Changes in Patients with Continuous-Flow Ventricular Assist Devices
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The clinical use of the newer continuous-flow pumps for mechanical circulatory support have resulted in superior outcomes including significantly reduced complication rates with improved durability over first generation pulsatile design pumps. However, as with all new technology, the newer LVADs have introduced a different set of management issues, as well as a unique risk profile into the mechanical circulatory support arena that were previously absent or unimportant with pulsatile LVADs. These include the effects of continuous flow on the systemic circulation and end-organ function, risk of thromboembolism, and pump thrombosis related to contact bearings in the blood path, the possible increased incidence of gastrointestinal bleeding, and ventricular arrhythmias, as well as alterations in the unloading characteristics of continuous-flow devices. This manuscript overviews the physiologic and pathologic effects that are associated with continuous-flow pumps and their unique management issues and complications.
- Frazier, O. H., Rose, E. A., Oz, M. C., et al. (2001). Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. Journal of thoracic and cardiovascular surgery, 122, 1186–1195. CrossRef
- Frazier, O. H., Rose, E. A., McCarthy, P., et al. (1995). Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system. Annals of Surgery, 222, 327–336. CrossRef
- Morgan, J. A., John, R., Rao, V., et al. (2004). Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience. Journal of thoracic and cardiovascular surgery, 127, 1309–1316. CrossRef
- Rose, E. A., Gelijns, A. C., Moskowitz, A. J., et al. (2001). Long-term mechanical left ventricular assistance for end-stage heart failure. New England Journal of Medicine, 345, 1435–1443. CrossRef
- Pagani, F. D., Long, J. W., Dembitsky, W. P., et al. (2006). Improved mechanical reliability of the HeartMate XVE left ventricular assist system. Annals of Thoracic Surgery, 82, 1413–1419. CrossRef
- Feller, E. D., Sorensen, E. N., Haddad, M., et al. (2007). Clinical outcomes are similar in pulsatile and nonpulsatile left ventricular assist device recipients. Annals of Thoracic Surgery, 83, 1082–1088. CrossRef
- Frazier, O. H., Gemmato, C., Myers, T. J., et al. (2007). Initial clinical experience with the HeartMate II axial-flow left ventricular assist device. Texas Heart Institute Journal, 34, 275–281.
- Miller, L. W., Pagani, F. D., Russell, S. D., et al. (2007). Use of a continuous-flow device in patients awaiting heart transplantation. New England Journal of Medicine, 357, 885–896. CrossRef
- John, R., Kamdar, F., Liao, K., et al. (2008). Improved survival and decreasing incidence of adverse events using the HeartMate II left ventricular assist device as a bridge-to-transplant. Annals of Thoracic Surgery, 86, 1227–1235. CrossRef
- John, R. (2008). Current axial flow pumps—HeartMate II and Jarvik LVADs. Seminars in Thoracic and Cardiovascular Surgery, 20, 264–272. CrossRef
- Rose, E. A., Levin, H. R., Oz, M. C., et al. (1994). Artificial circulatory support with textured interior surfaces: a counterintuitive approach to minimize thromboembolism. Circulation, 90(5 pt 2), II87–91.
- John, R., Kamdar, F., Liao, K., et al. (2008). Low thromboembolic risk with the HeartMate II left ventricular assist device. Journal of thoracic and cardiovascular surgery, 136, 1318–1323. CrossRef
- Letsou, G. V., Shah, N., Gregoric, I. D., et al. (2005). Gastrointestinal bleeding from arteriovenous malformations in patients supported by the Jarvik 2000 axial-flow left ventricular assist device. Journal of Heart and Lung Transplantation, 24, 105–109. CrossRef
- Crow, S., John, R., Boyle, A., et al. (2009). Gastrointestinal bleeding rates in recipients of non-pulsatile and pulsatile left ventricular assist devices. Journal of Thoracic and Cardiovascular Surgery, 137, 208–215. CrossRef
- Heyde, E. C. (1958). Gastrointestinal bleeding in aortic stenosis (letter). New England Journal of Medicine, 259, 196.
- Boley, S. J., Sammarteno, R., Adams A., et al. (1977). Vascular ectasias of the colon. On the nature and etiology of vascular ectasias of the colon. Gastroenterolgy, 72, 650–660.
- Warkentin, T. E., Moore, J. C., & Morgan, D. G. (1992). Aortic stenosis and bleeding gastrointestinal angiodysplasia: is acquired von Willebrand’s disease the link? Lancet, 340, 35–37. CrossRef
- Furlan, M. (1996). von Willebrand factor: molecular size and functional activity. Annals of Hematology, 72, 341–348. CrossRef
- Ruggeri, Z. M. (2003). von Willebrand factor. Current Opinion in Hematology, 10, 142–149. CrossRef
- Vincentelli, A., Susen, S., Le Tourneau, T., Six, I., Fabre, O., Juthier, F., et al. (2003). Acquired von Willebrand syndrome in aortic stenosis. New England Journal of Medicine, 349, 343–349. CrossRef
- Geisen, U., Heilmann, C., Beyersdorf, F., et al. (2008). Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease. European Journal of Cardiothoracic Surgery, 22, 679–684. CrossRef
- Weslowski, S., Fisher, J., & Welch, C. (1953). Perfusion of the pulmonary circulation by non-pulsatile flow. Surgery, 33, 370.
- Johnston, G. G., Hammill, F., Marzec, U., et al. (1976). Prolonged pulseless perfusion in unanesthetized calves. Archives of Surgery, 111, 1125–1130.
- Saito, S., Westaby, S., Piggot, D., et al. (2002). End-organ function during chronic nonpulsatile circulation. Annals of Thoracic Surgery, 74, 1080–1085. CrossRef
- Nakata, K., Shiono, M., Orime, Y., et al. (1996). Effect of pulsatile and nonpulsatile assist on heart and kidney microcirculation with cardiogenic shock. Artificial Organs, 20, 681–684. CrossRef
- Letsou, G. V., Myers, T. J., Gregoric, I. D., et al. (2003). Continuous axial-flow left ventricular assist device (Jarvik 2000) maintains kidney and liver perfusion for up to 6 months. Annals of Thoracic Surgery, 76, 1167–1170. CrossRef
- Radovancevic, B., Vrtovec, B., de Kort, E., Radovancevic, R., Gregoric, I. D., & Frazier, O. H. (2007). End-organ function in patients on long-term circulatory support with continuous or pulsatile-flow assist devices. Journal of Heart Transplantation, 26(8), 815–818. CrossRef
- Kamdar, F., Boyle, A., Liao, K., Colvin-Adams, M., Joyce, L., John, R. (2009). Effects of centrifugal, axial and pulsatile left ventricular assist device (LVAD) support on end-organ function in heart failure patients. Journal of Heart and Lung Transplantation (in press).
- Klotz, S., Deng, M. C., Stymann, J., et al. (2004). Left ventricular pressure and volume unloading during pulsatile versus nonpulsatile left ventricular assist device support. Annals of Thoracic Surgery, 77, 143–150. CrossRef
- Haft, J., Armstrong, W., Dyke, D. B., et al. (2007). Hemodynamic and exercise performance with pulsatile and continuous-flow left ventricular assist devices. Circulation, 116, I–8–15. CrossRef
- Thohan, V., Stetson, S. J., Nagueh, S. F., et al. (2005). Cellular and hemodynamic responses of failing myocardium to continuous flow mechanical circulatory support using the DeBakey-Noon left ventricular assist device: a comparative analysis with pulsatile-type devices. Journal of Heart Transplantation, 24, 566–575. CrossRef
- Garcia, S., Kamdar, F., Boyle, A., et al. (2008). Effects of pulsatile- and continuous-flow left ventricular assist devices on left ventricular unloading. Journal of Heart Transplantation, 27, 261–267. CrossRef
- Etz, C. D., Welp, H. A., Tjan, T. D., et al. (2007). Medically refractory pulmonary hypertension: treatment with nonpulsatile left ventricular assist devices. Annals of Thoracic Surgery, 83, 1697–1706. CrossRef
- Cao, X., Haft, J., Dyke, D. B., et al. Increased incidence of ventricular tachycardia following left ventricular assist device implantation with continuous flow rotary pumps. Presented at 10th Annual Scientific Meeting of the Heart Failure Society of America, Sep 2006, Seattle, WA.
- Vollkron, M., Voitl, P., Ta, J., et al. (2007). Suction events during left ventricular and ventricular arrhythmias. Journal of Heart Transplantation, 26, 819–825. CrossRef
- Wu, Yi., Allaire, P., Tao, G., et al. (2003). An advanced physiological controller design for a left ventricular assist device to prevent left ventricular collapse. Artificial Organs, 10, 926–930. CrossRef
- Vollkron, M., Schima, H., Huber, L., et al. (2006). Advanced suction detection for an axial flow pump. Artificial Organs, 9, 665–670. CrossRef
- Physiologic and Pathologic Changes in Patients with Continuous-Flow Ventricular Assist Devices
Journal of Cardiovascular Translational Research
Volume 2, Issue 2 , pp 154-158
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Left Ventricular Assist Device
- End-Stage Heart Failure
- Pulsatile Devices
- Continuous Flow Devices
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- 5. Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
- 2. Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- 3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- 4. Cardiovascular Division, Georgetown University-Washington Hospital Center, Washington, DC, USA