School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK.
Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA.
Exp Physiol. 2020 May;105(5):749-754. doi: 10.1113/EP088323. Epub 2020 Apr 3.
What is the topic of this review? Patients with advanced heart failure who are implanted with left ventricular assist devices (LVADs) present an opportunity to understand the human circulation under extreme conditions. What advances does it highlight? LVAD patients have a unique circulation that is characterized by a reduced or even absent arterial pulse. The remarkable survival of these patients is accompanied by circulatory complications, including stroke, gastrointestinal bleeding and right-heart failure. Understanding the mechanisms related to the complications in LVAD patients will help the patients and also advance our fundamental understanding of the human circulation in general.
Some humans with chronic, advanced heart failure are surgically implanted with a left ventricular assist device (LVAD). Because the LVAD produces a continuous flow, a palpable pulse is often absent in these patients. This allows for a unique investigation of the human circulation and has created a controversy around the 'need' for a pulse. The medical debate has also generated a more generic, fundamental discussion into what is 'normal' arterial physiology and health. The comprehensive study and understanding of the arterial responses to drastically altered haemodynamics due to continuous-flow LVADs, at rest and during activity, presents an opportunity to significantly increase our current understanding of the fundamental components of arterial regulation (flow, blood pressure, sympathetic activity, endothelial function, pulsatility) in a way that could never have been studied previously. In a series of four articles, we summarize the talks presented at the symposium entitled 'Bionic women and men - Physiology lessons from implantable cardiac devices' presented at the 2019 Annual Meeting of The Physiological Society in Aberdeen, UK. The articles highlight the novel questions generated by physiological phenomena observed in LVAD patients and propose future areas of interest within the field of cardiovascular physiology.
这篇综述的主题是什么？
患有晚期心力衰竭并植入左心室辅助装置（LVAD）的患者为了解人体在极端条件下的循环提供了机会。它强调了哪些进展？
LVAD 患者具有独特的循环，其特征是动脉脉搏减少甚至消失。这些患者令人瞩目的存活率伴随着循环并发症，包括中风、胃肠道出血和右心衰竭。了解与 LVAD 患者并发症相关的机制将有助于患者，并推进我们对人体循环的一般理解。
一些患有慢性、晚期心力衰竭的人接受了左心室辅助装置（LVAD）的手术植入。由于 LVAD 产生连续的血流，这些患者通常没有可触及的脉搏。这允许对人体循环进行独特的研究，并围绕着“需要”脉搏产生了争议。医学辩论也引发了更普遍、更基本的讨论，即动脉生理学和健康的“正常”是什么。全面研究和理解由于连续流动 LVAD 导致的血流动力学剧烈改变对动脉反应，无论是在休息时还是在活动时，都为我们提供了一个机会，可以以前所未有的方式显著增加我们对动脉调节（流量、血压、交感神经活动、内皮功能、脉动性）基本组成部分的现有理解。在一系列四篇文章中，我们总结了在英国阿伯丁举行的 2019 年英国生理学会年会上题为“仿生男女——植入式心脏设备带来的生理学教训”的专题研讨会的演讲内容。这些文章强调了在 LVAD 患者中观察到的生理现象所产生的新问题，并提出了心血管生理学领域未来的研究兴趣领域。
