Clinical implications of physiologic flow adjustment in continuous-flow left ventricular assist devices

Vakhtang Tchantchaleishvili*, Jessica G Y Luc, Caitlin M. Cohan, Kevin Phan, Laila Hübbert, Steven W. Day, H. Todd Massey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

There is increasing evidence for successful management of end-stage heart failure with continuous-flow left ventricular assist device (CF-LVAD) technology. However, passive flow adjustment at fixed CF-LVAD speed is susceptible to flow balancing issues as well as adverse hemodynamic effects relating to the diminished arterial pulse pressure and flow. With current therapy, flow cannot be adjusted with changes in venous return, which can vary significantly with volume status. This limits the performance and safety of CF-LVAD. Active flow adjustment strategies have been proposed to improve the synchrony between the pump and the native cardiovascular system, mimicking the Frank-Starling mechanism of the heart. These flow adjustment strategies include modulation by CF-LVAD pump speed by synchrony and maintenance of constant flow or constant pressure head, or a combination of these variables. However, none of these adjustment strategies have evolved sufficiently to gain widespread attention. Herein we review the current challenges and future directions of CF-LVAD therapy and sensor technology focusing on the development of a physiologic, long-term active flow adjustment strategy for CF-LVADs.

Original languageEnglish
Pages (from-to)241-250
Number of pages10
JournalASAIO Journal
Volume63
Issue number3
DOIs
Publication statusPublished - May 2017
Externally publishedYes

Keywords

  • LVAD
  • flow adjustment
  • sensors

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