TY - JOUR
T1 - The Unique Blood Pressures and Pulsatility of LVAD Patients
T2 - Current Challenges and Future Opportunities
AU - Castagna, Francesco
AU - Stöhr, Eric J.
AU - Pinsino, Alberto
AU - Cockcroft, John R.
AU - Willey, Joshua
AU - Reshad Garan, A.
AU - Topkara, Veli K.
AU - Colombo, Paolo C.
AU - Yuzefpolskaya, Melana
AU - McDonnell, Barry J.
N1 - Publisher Copyright:
© 2017, The Author(s).
PY - 2017/10/18
Y1 - 2017/10/18
N2 - An increasing number of end-stage heart failure patients are now implanted with continuous-flow left ventricular assist devices (CF-LVADs). Although this therapeutic approach is associated with improved clinical outcomes, continuous flow physiology reduces arterial pulse pressure and pulsatility to an extent that is unique to this population. Recent data suggest that high blood pressure (BP) contributes to life-threatening complications such as pump thrombosis and stroke of CF-LVAD patients. However, limited understanding of the distinct hemodynamics of these pumps makes measurement and, consequently, medical management of BP quite challenging. Here, we review the evolution of LVAD design, the impact of CF-LVAD flow, and “artificial pulse” technology on hemodynamics and BP measurement, as well as suggest new approaches for the assessment and interpretation of the unique physiology of modern LVADs.
AB - An increasing number of end-stage heart failure patients are now implanted with continuous-flow left ventricular assist devices (CF-LVADs). Although this therapeutic approach is associated with improved clinical outcomes, continuous flow physiology reduces arterial pulse pressure and pulsatility to an extent that is unique to this population. Recent data suggest that high blood pressure (BP) contributes to life-threatening complications such as pump thrombosis and stroke of CF-LVAD patients. However, limited understanding of the distinct hemodynamics of these pumps makes measurement and, consequently, medical management of BP quite challenging. Here, we review the evolution of LVAD design, the impact of CF-LVAD flow, and “artificial pulse” technology on hemodynamics and BP measurement, as well as suggest new approaches for the assessment and interpretation of the unique physiology of modern LVADs.
KW - Blood pressure
KW - Continuous flow
KW - Heart failure
KW - Hemodynamics
KW - Left ventricular assist device
KW - Mechanical circulatory support
UR - http://www.scopus.com/inward/record.url?scp=85032029012&partnerID=8YFLogxK
U2 - 10.1007/s11906-017-0782-6
DO - 10.1007/s11906-017-0782-6
M3 - Review article
C2 - 29043581
AN - SCOPUS:85032029012
SN - 1522-6417
VL - 19
JO - Current Hypertension Reports
JF - Current Hypertension Reports
IS - 10
M1 - 85
ER -