Tchantchaleishvili Vakhtang, Luc Jessica G Y, Cohan Caitlin M, Phan Kevin, Hübbert Laila, Day Steven W, Massey H Todd
From the *Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; †Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; ‡Department of Surgery, Alameda Health System, Oakland, California; §Faculty of Medicine, University of Sydney, Sydney, Australia; ¶Department of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden; ‖1Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, New York; and #Department of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky.
ASAIO J. 2017 May/Jun;63(3):241-250. doi: 10.1097/MAT.0000000000000477.
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.
越来越多的证据表明，连续流左心室辅助装置（CF-LVAD）技术在终末期心力衰竭的治疗中取得了成功。然而，在固定的CF-LVAD速度下进行被动流量调节容易出现流量平衡问题以及与动脉脉压和流量降低相关的不良血流动力学效应。在当前的治疗中，流量无法随着静脉回流的变化而调节，而静脉回流会随着容量状态的变化而显著改变。这限制了CF-LVAD的性能和安全性。为了改善泵与天然心血管系统之间的同步性，模仿心脏的Frank-Starling机制，人们提出了主动流量调节策略。这些流量调节策略包括通过同步调节CF-LVAD泵速以及维持恒定流量或恒定压头，或这些变量的组合。然而，这些调节策略都没有充分发展到引起广泛关注的程度。在此，我们回顾CF-LVAD治疗和传感器技术的当前挑战及未来方向，并重点关注针对CF-LVAD的生理性长期主动流量调节策略的发展。
