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不同版本轴流和离心 LVAD 的对比评估:综述。

Comparative assessment of different versions of axial and centrifugal LVADs: A review.

机构信息

Mechanical and Industrial Engineering Department, IIT Roorkee, Roorkee, India.

Department of Mechanical Engineering, IIT Kharagpur, Kharagpur, India.

出版信息

Artif Organs. 2021 Jul;45(7):665-681. doi: 10.1111/aor.13914. Epub 2021 Mar 15.

Abstract

Continuous-flow left ventricular assist devices (LVADs) have gained tremendous acceptance for the treatment of end-stage heart failure patients. Among different versions, axial flow and centrifugal flow LVADs have shown remarkable potential for clinical implants. It is also very crucial to know which device serves its purpose better to treat heart failure patients. A thorough comparison of axial and centrifugal LVADs, which may guide doctors in deciding before the implant, still lacks in the literature. In this work, an assessment of axial and centrifugal LVADs has been made to suggest a better device by comparing their engineering, clinical, and technological development of design aspects. Hydrodynamic and hemodynamic aspects for both types of pumps are discussed along with their biocompatibility, bearing types, and sizes. It has been observed numerically that centrifugal LVADs perform better over axial LVADs in every engineering aspect like higher hydraulic efficiency, better characteristics curve, lesser power intake, and also lesser blood damage. However, the clinical outcomes suggest that centrifugal LVADs experience higher events of infections, renal, and respiratory dysfunction. In contrast, axial LVADs encountered higher bleeding and cardiac arrhythmia. Moreover, recent technological developments suggested that magnetic type bearings along with biocompatible coating improve the life of LVADs.

摘要

连续流动左心室辅助装置(LVAD)已被广泛用于治疗终末期心力衰竭患者。在不同的版本中,轴流和离心流 LVAD 在临床植入方面显示出了巨大的潜力。了解哪种设备更能有效地治疗心力衰竭患者也非常重要。然而,文献中仍然缺乏对轴流和离心 LVAD 进行全面比较的研究,这可能有助于医生在植入前做出决策。在这项工作中,通过比较两种泵的工程、临床和技术设计方面的发展,对轴流和离心 LVAD 进行了评估,以提出更好的设备。对两种类型的泵的流体动力学和血液动力学方面进行了讨论,以及它们的生物相容性、轴承类型和尺寸。数值研究表明,离心 LVAD 在每一个工程方面都优于轴流 LVAD,例如更高的水力效率、更好的特性曲线、更少的功率输入,以及更少的血液损伤。然而,临床结果表明,离心 LVAD 更容易出现感染、肾脏和呼吸功能障碍等问题。相比之下,轴流 LVAD 更容易出现出血和心律失常等问题。此外,最近的技术发展表明,磁性轴承和生物相容性涂层可以提高 LVAD 的使用寿命。

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