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      Does pulsatility matter in the era of continuous-flow blood pumps?

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          Abstract

          Despite significant improved survival with continuous flow left ventricular assist devices (LVADs), complications related to aortic valve insufficiency, gastrointestinal bleeding, stroke, pump thrombosis, and hemolysis have dampened the long term success of these pumps. Evolution has favored a pulsatile heart pump to be able to deliver the maximum flow at different levels of systemic vascular resistance, confer kinetic energy to the flow of blood past areas of stenosis and generate low shear stress on blood elements. In this perspective, we suggest that lack of pulsatility may be one factor that has limited the success of continuous flow LVADs and suggest that research needs to focus on methods to generate pulsatility either by the native heart or by various speed modulation algorithms.

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          Author and article information

          Journal
          J. Heart Lung Transplant.
          The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
          Elsevier BV
          1557-3117
          1053-2498
          Aug 2015
          : 34
          : 8
          Affiliations
          [1 ] Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: moazamn@ccf.org.
          [2 ] Department of Cardiac Surgery, Sharp Memorial Hospital, San Diego, California.
          [3 ] Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute.
          [4 ] Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio.
          [5 ] Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
          Article
          S1053-2498(14)01347-3
          10.1016/j.healun.2014.09.012
          25447568
          9af8c953-221b-4f93-9f50-3805309a6b28
          History

          LVAD,LVAD complications,continuous flow,mechanical circulatory support,pulsatility

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