Pablo Huang Zhang1,2, J Yasha Kresh3,4. 1. Department of Cardiothoracic Surgery, Drexel University College of Medicine, 245 N. 15th Street, Room 6320, MS 111, Philadelphia, PA, 19102, USA. 2. School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA. 3. Department of Cardiothoracic Surgery, Drexel University College of Medicine, 245 N. 15th Street, Room 6320, MS 111, Philadelphia, PA, 19102, USA. jk45@drexel.edu. 4. School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA. jk45@drexel.edu.
Abstract
PURPOSE OF REVIEW: This review describes the current state of advancements in mechanical circulatory support (MCS) devices with significantly improved hemodynamic performance and decreased adverse events. Novel considerations for future MCS designs that impart spiral flow regimes will be detailed. RECENT FINDINGS: Significant challenges in MCS device use have included size reduction, premature pump mechanical bearing failure, acquired bleeding disorders, and vascular complications related to high shear forces and jetting. Some of these problems have been improved upon, such as the use of magnetically levitated impellers and hydrodynamic bearings. The relative simplicity of continuous flow pumps has also enabled their miniaturization, portability, and reduced energy consumption. Recent studies by our group demonstrated that spiral forms of flow possess hemodynamically beneficial attributes at the MCS outflow cannula and aorta interface, reducing jet impact, organizing streamlines, and thereby improving endothelial function through wall shear stress modulation. Despite MCS design improvements, they are far from perfect. Induced spiral fluid modulation may help address the known flow-mediated disturbances in vascular mechanobiology.
PURPOSE OF REVIEW: This review describes the current state of advancements in mechanical circulatory support (MCS) devices with significantly improved hemodynamic performance and decreased adverse events. Novel considerations for future MCS designs that impart spiral flow regimes will be detailed. RECENT FINDINGS: Significant challenges in MCS device use have included size reduction, premature pump mechanical bearing failure, acquired bleeding disorders, and vascular complications related to high shear forces and jetting. Some of these problems have been improved upon, such as the use of magnetically levitated impellers and hydrodynamic bearings. The relative simplicity of continuous flow pumps has also enabled their miniaturization, portability, and reduced energy consumption. Recent studies by our group demonstrated that spiral forms of flow possess hemodynamically beneficial attributes at the MCS outflow cannula and aorta interface, reducing jet impact, organizing streamlines, and thereby improving endothelial function through wall shear stress modulation. Despite MCS design improvements, they are far from perfect. Induced spiral fluid modulation may help address the known flow-mediated disturbances in vascular mechanobiology.
Authors: Omar Wever-Pinzon; Craig H Selzman; Stavros G Drakos; Abdulfattah Saidi; Gregory J Stoddard; Edward M Gilbert; Mohamed Labedi; Bruce B Reid; Erin S Davis; Abdallah G Kfoury; Dean Y Li; Josef Stehlik; Feras Bader Journal: Circ Heart Fail Date: 2013-03-11 Impact factor: 8.790
Authors: Spencer D Lalonde; Ana C Alba; Alanna Rigobon; Heather J Ross; Diego H Delgado; Filio Billia; Michael McDonald; Robert J Cusimano; Terrence M Yau; Vivek Rao Journal: J Card Surg Date: 2013-07-11 Impact factor: 1.620