Bionic women and men ‐ Part 2: Arterial stiffness in heart failure patients implanted with left ventricular assist devices

Abstract

In parallel with the major advances in clinical care, technological advancements and implantation of mechanical circulatory support in patients with severe heart failure have resulted in these patients living longer. However, these patients are still at increased risk of stroke and gastrointestinal bleeding. The unique continuous flow produced by various left ventricular assist devices (LVADs) has been suggested as one potential reason for this increased risk of stroke and gastrointestinal bleeding. Furthermore, these continuous-flow (CF) devices challenge our understanding of circulatory blood pressure and flow regulation in relationship to organ health. In healthy pulsatile and dynamic systems, arterial stiffness is a major independent risk factor for stroke. However, to date, there are limited data regarding the impact of CF-LVAD therapy on arterial stiffness. The purpose of this report is to discuss the variable impact of CF-LVAD therapy on arterial stiffness and attempt to highlight some potential mechanisms linking these associations in this unique population.

Impact of Mechanical Circulatory Support on Exercise Capacity in Patients With Advanced Heart Failure

“…The type of hemodynamic support provided by current-generation LVADs is quite distinct from normal physiology (49)(50)(51)(52)(53)(54)(55)(56)(57)(58). LVADs provide "continuous-flow" circulatory support because the rotating impeller, housed within the device itself, creates a suction effect, in essencepulling oxygenated blood out of the LV and continuously propelling it to the body.…”