Institute of Cardiology, Pitié-Salpêtrière Hospital, CHU Pitié-Salpêtrière, AP-HP, Sorbonne University, Boulevard de l'Hôpital, 75013 Paris, France.
Institute of Cardiology, Pitié-Salpêtrière Hospital, CHU Pitié-Salpêtrière, AP-HP, Sorbonne University, Boulevard de l'Hôpital, 75013 Paris, France.
Arch Cardiovasc Dis. 2020 Jun-Jul;113(6-7):461-472. doi: 10.1016/j.acvd.2020.03.017. Epub 2020 Jul 9.
Heart failure affects more than 30 million people worldwide and its prevalence is constantly rising. In 2020, heart transplantation is the only curative treatment, but left ventricular assistance devices (LVADs) are fully integrated into the decision algorithm for management of patients with advanced heart failure, with more than 20,000 devices implanted worldwide in the last decade. Intended to support cardiac output, LVADs remove the blood from the left ventricle and eject it into the proximal aorta. Whereas first-generation LVADs were pulsatile, second- and third-generation LVADs are more reliable, but create a laminar flow, with reduced (or absent) blood flow pulsatility. Concomitantly, several new adverse events, some of them lethal, appeared when continuous-flow LVADs started to be implanted, including acquired von Willebrand disease, gastrointestinal bleeding and aortic valve fusion or regurgitation. This review aims to apply models describing pulsatility (such as the Windkessel effect applied by Frank, Guyton's continuity model of venous return and Sunagawa's left ventricular-arterial coupling) to LVADs, to better understand the physiopathology in patients using continuous-flow devices. This review also covers the means of exploring pulsatility and adverse events associated with a reduction in pulsatility, as well as the possible ways for restoring pulsatility in patients implanted with an LVAD.
心力衰竭影响全球超过 3000 万人，其患病率不断上升。2020 年，心脏移植是唯一的治愈性治疗方法，但左心室辅助装置（LVAD）已完全纳入晚期心力衰竭患者管理的决策算法中，在过去十年中，全球已植入超过 20000 个装置。LVAD 的目的是支持心输出量，将血液从左心室抽出并喷射到近端主动脉。第一代 LVAD 为脉动式，第二代和第三代 LVAD 更可靠，但产生层流，血液流动脉动减少（或消失）。当连续流 LVAD 开始植入时，同时出现了几种新的不良事件，其中一些是致命的，包括获得性血管性血友病、胃肠道出血以及主动脉瓣融合或反流。本综述旨在将描述脉动性的模型（如应用于 Frank 的脉管腔模型、Guyton 的静脉回流连续模型和 Sunagawa 的左心室-动脉耦联）应用于 LVAD，以更好地理解使用连续流装置的患者的病理生理学。本综述还涵盖了探索脉动性和与脉动性降低相关的不良事件的方法，以及为植入 LVAD 的患者恢复脉动性的可能方法。
