Acute and chronic effects of continuous‐flow support and pulsatile‐flow support

Miyamoto, Takuma; Karimov, Jamshid H.; Fukamachi, Kiyotaka

doi:10.1111/aor.13446

Cited by 5 publications

(4 citation statements)

References 50 publications

(65 reference statements)

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“…In clinical CF LVAD support, several adverse effects, including remodeling and structural changes in human vessels, aortic insufficiency, gastrointestinal bleeding, and acquired vWF disease have been reported, and a PF LVAD is expected to solve these issues 21 . As shown in Figure 6, the trans‐valve LVAD enabled pulsatile blood perfusion, and as the rotational speed increased from 16 800 to 26 400 rpm, the pulsatile pressure and pulsatile index decreased 26% and 34%, respectively.…”

Section: Discussionmentioning

confidence: 99%

In vitro performance of trans‐valve left ventricular assist device installed at aortic valve position

et al. 2020

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In this study, we developed a trans‐valve left ventricular assist device (LVAD) that unites a rear‐impeller axial‐flow blood pump (AFBP) and a polymer membrane valve placed at the aortic valve position. The diameter and length of the rear impeller AFBP was 12 and 63 mm, respectively. The polymer membrane valve was similar to the jelly‐fish valve consisting of a valve leaflet made of silicone rubber (thickness 0.5 mm), valve ring (diameter: 25 mm), and valve spokes. The trans‐valve LVAD was examined in a mock circulation. An implantable pulsatile flow (PF) VAD was connected to an atrial reservoir to simulate the left ventricle (LV), and the Hall valve was worn in the inflow port, and the trans‐valve LVAD was placed in the outflow port as an outflow valve. When the motor rotational speed increased to 26 400 rpm, the mean aortic flow increased from 4.2 to 5.3 L/min, mean aortic pressure increased from 83.4 to 100 mm Hg, and mean motor current of the implantable PF VAD decreased from 1.18 to 0.94 A (unloading effect on LV −21%). The energy equivalent pressure increased from 85.2 to 102 mm Hg, and surplus hemodynamic energy (SHE) decreased by −15.4% from the baseline. In conclusion, the trans‐valve LVAD has an advantage of preserving pulsatility without any complicated mechanism and is a novel and promising LV support device.

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Section: Discussionmentioning

confidence: 99%

In vitro performance of trans‐valve left ventricular assist device installed at aortic valve position

et al. 2020

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“…High laminar flow also induces elongation and alignment of ECs in the flow direction, while low/disturbed flow does not 25,26 . Furthermore, clinical applications of mechanical circulatory support have shown that continuous flow support (i.e., lacking pulsatility) can lead to EC dysfunction and clinical complications 27 .…”

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confidence: 99%

Early events in endothelial flow sensing

et al. 2021

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Responses of vascular and lymphatic endothelial cells (ECs) to fluid shear stress (FSS) from blood or lymphatic fluid flow govern the development, physiology, and diseases of these structures. Extensive research has characterized the signaling, gene expression and cytoskeletal pathways that mediate effects on EC phenotype and vascular morphogenesis. But the primary mechanisms by which ECs transduce the weak forces from flow into biochemical signals are less well understood. This review covers recent advances in our understanding of the immediate mechanisms of FSS mechanotransduction, integrating results from different disciplines, addressing their roles in development, physiology and disease, and suggesting important questions for future work.

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“…Although early CPB pulsatile pumps introduced greater complexity and only marginal benefits in the 1950s and 1960s, a few pulsatile roller pumps showed advanced commercial production and clinical use in the late 1970s and early 1980s after demonstrating lower mortality rates and a decreased need for postoperative intra‐aortic balloon pulsation . Despite this, the controversy over the benefits of pulsatile flow during acute and long‐term extracorporeal circulation still continues . Our pediatric cardiovascular research team at Penn State Children's Hospital and Penn State College of Medicine has a long‐standing dedication to this controversial debate and uses a multidisciplinary translational research approach to further examine this issue .…”

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confidence: 99%