Debate

Abstract

The speculative benefits of augmented pulsatility with continuous flow LVADs could be overrated and are still incompletely evaluated. Potential risks that might arise from this strategy should be carefully weighed before implementing extensive pulsatility as standard patient management.

Designing an Active Valvulated Outflow Conduit for a Continuous-Flow Left Ventricular Assist Device to Increase Pulsatility: A Simulation Study

“…To conclude, as Schima et al 9 interestingly described, all the available systems to increase pulsatility in continuousflow VADs generate a limited amount of pulsatility that cannot mimic a natural pulse. So the authors asked if VAD patients could really benefit from this small increase in pulsatility.…”

“…It should also be considered that this increase in pulsatility is only due to the presence of the valvulated conduit and that further increase in PLS could be obtained, assuring the aortic valve opening as it is done in clinical practice. Unfortunately, as also stated by Schima et al, 9 all the existing algorithms cannot, for now, restore the physiological pulsatility.…”

“…However, because of the longer VAD staying, the continuous-flow VADs could cause alteration to arterial walls. [1][2][3][6][7][8][9] To overcome this dilemma, research is now focused on the possibility to increase the pulsatility of continuous-flow VADs adopting different strategies mainly based on speed modulation. [10][11][12][13][14][15][16][17]20,21 Ando et al 10 tested on animals the rotational speed modulation implemented in the EVAHEART.…”

“…Among the hypothetical clinical advantages of pulsatile circulation in VAD are reduced blood stasis in the ventricle, beneficial exercising of the aortic valve, improved washing on the distal side of atherosclerotic lesions, increased coronary artery perfusion, reduced risk of ventricular suction, reducing of pulmonary vascular resistance and compatibility with myocardial recovery, and weaning from circulatory support. [6][7][8][9] Nowadays, research is focused on the development of strategies to increase the pulsatility of continuous-flow VADs. The last generation of continuous-flow VADs incorporates algorithms to generate pulsatility.…”

“…Among the hypothetical clinical advantages of pulsatile circulation in VAD are reduced blood stasis in the ventricle, beneficial exercising of the aortic valve, improved washing on the distal side of atherosclerotic lesions, increased coronary artery perfusion, reduced risk of ventricular suction, reducing of pulmonary vascular resistance and compatibility with myocardial recovery, and weaning from circulatory support. 6-9…”