Evaluation of the effect of diminished pulsatility as seen in continuous flow ventricular assist devices on arterial endothelial cell phenotype and function

Patibandla, Phani K.; Rajasekaran, Namakkal S.; Shelar, Sandeep; Giridharan, Guruprasad A.; Litovsky, Silvio; Sethu, Palaniappan

doi:10.1016/j.healun.2016.03.008

Cited by 26 publications

(19 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, histologic comparisons of aortic tissue before and after LVAD implantation have demonstrated evidence of vascular inflammation with increased expression of vascular adhesion molecules after CF-LVAD placement 50 . Such findings of an inflammatory response as well as increased expression of antioxidant genes have also been observed in human aortic endothelial cells cultured in vitro and exposed to non-pulsatile flow to replicate CF-LVAD support 51 .…”

Section: Vascular Adaptations To Non-pulsatile Flowsupporting

confidence: 57%

Living Without a Pulse

Purohit¹,

Cornwell²,

Pal³

et al. 2018

Circ: Heart Failure

View full text Add to dashboard Cite

Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability have improved with CF-LVADs, patients supported with CF-LVADs have a high rate of complications that were not as frequently observed with older pulsatile devices, including gastrointestinal bleeding from arteriovenous malformations, pump thrombosis, and stroke. Given the apparent fundamental biological role of the pulse, the purpose of this review is to describe the normal physiology of ventricular-arterial coupling from pulsatile flow, the effects of heart failure on this physiology and the vasculature, and to examine the effects of nonpulsatile blood flow on the vascular system and potential role in complications seen with CF-LVAD therapy. Understanding these concomitant vascular changes with CF-LVADs may be a key step in improving patient outcomes as modulation of pulsatility and flow characteristics may serve as a novel, yet simple, therapy for reducing complications.

show abstract

Section: Vascular Adaptations To Non-pulsatile Flowsupporting

confidence: 57%

Living Without a Pulse

Purohit¹,

Cornwell²,

Pal³

et al. 2018

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…First, continuous flow compared to normal pulsatile blood flow has been reported to impair endothelial cell function via oxidative stress and cytoskeletal and mitochondrial alterations. 16 In turn, endothelial dysfunction in the artery lumen impacts the adventitia by increasing hydraulic transport of solutes, microparticles, and oxidation products through the vessel wall. 17,18 Hemodynamic conditions, including pulsatility, arterial pressure, and wall permeability, further influence outward mass transport in the artery wall.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Remodeling and Fibrosis With Continuous-Flow Left Ventricular Assist Device Support

Ambardekar¹,

Weiser‐Evans

Li³

et al. 2018

Circ: Heart Failure

View full text Add to dashboard Cite

Among patients supported with CF-LVADs, the coronary arteries develop marked remodeling with increased adventitial fibrosis. The physiological consequences of these structural changes are unknown, but it is possible that arterial contractility may be impaired, thus limiting coronary flow reserve and promoting myocardial ischemia. This may contribute to CF-LVAD complications, such as ventricular arrhythmias and right ventricular failure. As more patients receive CF-LVADs and new pump technology attempts to modulate flow profiles and pulsatility, further research is needed to understand the mechanisms and long-term sequela of these changes in coronary arteries and other vascular beds.

show abstract

“…Disturbed flow, similar to the infrarenal segment of an atherosclerotic abdominal aorta, was generated in this model by removing the one-way valve (thus allowing retrograde flow) and lowering the flow rate to mimic the flow velocity and shear stress experienced by the aortic ECs in vivo. In addition to modeling disturbed flow profiles, our lab group has used the ECCM in two studies to compare the effects of arterial physiologic pulsatile fluid flow on arterial ECs to those of continuous flow, as seen in patients with a continuous-flow ventricular assist device (CF-VAD) (Figure 3b) [83,84]. We replicated physiologic arterial flow in vitro by tuning the pump settings and resistance and bypassing the compliance element, generating peak systolic/diastolic pressures of approximately 120/80 mmHg, 6-8% stretch, and a 9 mL/min flow rate at a pump frequency of 80 beats/min.…”

Section: Examples Of Vascular Tissue Chipsmentioning

confidence: 99%

Tissue Chips and Microphysiological Systems for Disease Modeling and Drug Testing

et al. 2021

Self Cite

View full text Add to dashboard Cite

Tissue chips (TCs) and microphysiological systems (MPSs) that incorporate human cells are novel platforms to model disease and screen drugs and provide an alternative to traditional animal studies. This review highlights the basic definitions of TCs and MPSs, examines four major organs/tissues, identifies critical parameters for organization and function (tissue organization, blood flow, and physical stresses), reviews current microfluidic approaches to recreate tissues, and discusses current shortcomings and future directions for the development and application of these technologies. The organs emphasized are those involved in the metabolism or excretion of drugs (hepatic and renal systems) and organs sensitive to drug toxicity (cardiovascular system). This article examines the microfluidic/microfabrication approaches for each organ individually and identifies specific examples of TCs. This review will provide an excellent starting point for understanding, designing, and constructing novel TCs for possible integration within MPS.

show abstract

Evaluation of the effect of diminished pulsatility as seen in continuous flow ventricular assist devices on arterial endothelial cell phenotype and function

Cited by 26 publications

References 5 publications

Living Without a Pulse

Living Without a Pulse

Coronary Artery Remodeling and Fibrosis With Continuous-Flow Left Ventricular Assist Device Support

Tissue Chips and Microphysiological Systems for Disease Modeling and Drug Testing

Contact Info

Product

Resources

About