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Physiologic and hematologic concerns of rotary blood pumps: what needs to be improved?

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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.

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Conflict of interest

Tohid Pirbodaghi, Chris Cotter, and Kevin Bourque are R&D researchers at Thoratec Corporation in Burlington, MA, USA. The authors have no financial or personal relationships that could inappropriately influence or bias this work.

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Authors and Affiliations

  1. Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland

    Tohid Pirbodaghi

  2. ARTORG Cardiovascular Engineering, University of Bern, Murtenstrasse 50, 3010, Bern, Switzerland

    Tohid Pirbodaghi

  3. Department of Surgery-Cardiac Section, School of Medicine, Yale University, New Haven, CT, USA

    Siavash Asgari

  4. Thoratec Corporation, Burlington, MA, USA

    Tohid Pirbodaghi, Chris Cotter & Kevin Bourque

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  1. Tohid Pirbodaghi
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  2. Siavash Asgari
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  4. Kevin Bourque
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Correspondence to Tohid Pirbodaghi.

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Pirbodaghi, T., Asgari, S., Cotter, C. et al. Physiologic and hematologic concerns of rotary blood pumps: what needs to be improved?. Heart Fail Rev 19, 259–266 (2014). https://doi.org/10.1007/s10741-013-9389-4

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