Department of Cardiac Surgery, Research and Innovation Unit, RHU BioArt Lung 2020, Marie Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France.
Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA.
Can J Cardiol. 2020 Feb;36(2):170-183. doi: 10.1016/j.cjca.2019.11.002. Epub 2019 Nov 9.
Mechanical circulatory support (MCS) has made rapid progress over the last 3 decades. This was driven by the need to develop acute and chronic circulatory support as well as by the limited organ availability for heart transplantation. The growth of MCS was also driven by the use of extracorporeal membrane oxygenation (ECMO) after the worldwide H1N1 influenza outbreak of 2009. The majority of mechanical pumps (ECMO and left ventricular assist devices) are currently based on continuous flow pump design. It is interesting to note that in the current era, we have reverted from the mammalian pulsatile heart back to the continuous flow pumps seen in our simple multicellular ancestors. This review will highlight key physiological concepts of the assisted circulation from its effects on cardiac dynamic to principles of cardiopulmonary fitness. We will also examine the physiological principles of the ECMO-assisted circulation, anticoagulation, and the haemocompatibility challenges that arise when the blood is exposed to a foreign mechanical circuit. Finally, we conclude with a perspective on smart design for future development of devices used for MCS.
在过去的 30 年中，机械循环支持（MCS）取得了飞速的发展。这是由于需要开发急性和慢性循环支持，以及心脏移植供体器官的有限性。体外膜氧合（ECMO）在 2009 年全球 H1N1 流感爆发后也得到了广泛应用，这也推动了 MCS 的发展。目前，大多数机械泵（ECMO 和左心室辅助装置）都基于连续流泵设计。有趣的是，在当前时代，我们已经从哺乳动物的脉动心脏回到了我们简单的多细胞祖先所看到的连续流泵。本综述将重点介绍辅助循环的关键生理概念，从其对心脏动力学的影响到心肺适应性的原则。我们还将研究 ECMO 辅助循环的生理原理、抗凝以及血液暴露于外来机械回路时出现的血液相容性挑战。最后，我们对未来用于 MCS 的设备的智能设计进行了展望。
