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The Physiological Rationale for Incorporating Pulsatility in Continuous-Flow Left Ventricular Assist Devices

Grosman-Rimon, Liza, PhD*,†; Billia, Filio, MD, PhD; Kobulnik, Jeremy, MD‡,§; Pollock Bar-Ziv, Stacey, PhD; Cherney, David Z., MD, PhD¶,‖; Rao, Vivek, MD, PhD*

doi: 10.1097/CRD.0000000000000202
Review Articles

Over the past few decades, left ventricular assist device (LVAD) support has extended the lives of many patients with end-stage heart failure. The most common devices are continuous-flow (CF) LVADs. The use of the CF-LVADs has required that clinicians learn the physiological and clinical consequences of long-term continuous blood flow. While this alteration in the normal physiology still offers advantages from mechanical circulatory support, the lack of pulsatility may also increase the likelihood of adverse events. However, it is currently unknown whether newly evolved devices should incorporate pulsatility. In this article, we discuss the possible benefits of incorporating pulsatility, while maintaining the benefits of the CF-LVAD, to maximize the treatment of patients.

From the *Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Institute, University Health Network, University of Toronto, Toronto, Canada

Toronto Rehabilitation Institute, University Health Network, Toronto, Canada

Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Institute, University Health Network, Toronto, Canada

§Sinai Health System, Division of Cardiology, Mount Sinai Hospital, Toronto, Canada

Faculty of Medicine, University of Toronto, Toronto, Canada

Division of Nephrology, Departments of Medicine and Physiology, University Health Network, University of Toronto, Toronto, Canada.

Disclosures: Vivek Rao is a consultant to Terumo, CorMatrix, and HeartWare. The other authors have no conflicts of interest to disclose.

Correspondence: Vivek Rao, MD, PhD, 4N-457, 200 Elizabeth Street, Toronto, Ontario, Canada, M5G 2C4. E-mail: Vivek.Rao@uhn.ca

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