Department of Cardiothoracic Surgery, Drexel University College of Medicine, 245 N. 15th Street, Room 6320, MS 111, Philadelphia, PA, 19102, USA.
School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
Curr Cardiol Rep. 2018 Aug 22;20(10):94. doi: 10.1007/s11886-018-1037-0.
This review describes the current state of advancements in mechanical circulatory support (MCS) devices with significantly improved hemodynamic performance and decreased adverse events. Novel considerations for future MCS designs that impart spiral flow regimes will be detailed.
Significant challenges in MCS device use have included size reduction, premature pump mechanical bearing failure, acquired bleeding disorders, and vascular complications related to high shear forces and jetting. Some of these problems have been improved upon, such as the use of magnetically levitated impellers and hydrodynamic bearings. The relative simplicity of continuous flow pumps has also enabled their miniaturization, portability, and reduced energy consumption. Recent studies by our group demonstrated that spiral forms of flow possess hemodynamically beneficial attributes at the MCS outflow cannula and aorta interface, reducing jet impact, organizing streamlines, and thereby improving endothelial function through wall shear stress modulation. Despite MCS design improvements, they are far from perfect. Induced spiral fluid modulation may help address the known flow-mediated disturbances in vascular mechanobiology.
本文描述了机械循环支持（MCS）设备在显著改善血液动力学性能和减少不良事件方面的最新进展。本文将详细介绍未来赋予螺旋流动状态的 MCS 设计的新考虑因素。
MCS 设备使用中存在一些重大挑战，包括体积缩小、泵机械轴承过早失效、获得性出血障碍以及与高剪切力和射流相关的血管并发症。其中一些问题已经得到改善，例如使用磁悬浮叶轮和液动轴承。连续流泵的相对简单性也使其能够实现小型化、便携化和降低能耗。我们小组最近的研究表明，在 MCS 流出套管和主动脉接口处，螺旋流动形式具有血液动力学有益特性，减少射流冲击，组织流线，从而通过壁面切应力调节改善内皮功能。尽管 MCS 设计有所改进，但它们远非完美。诱导的螺旋流调节可能有助于解决血管力学生物学中已知的流动介导的干扰。
