连续血流左心室辅助装置治疗的生理学。

IF 4.2 2区 医学 Q1 PHYSIOLOGY
Andrew N Rosenbaum, James F Antaki, Atta Behfar, Mauricio A Villavicencio, John Stulak, Sudhir S Kushwaha
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引用次数: 3

摘要

持续血流左心室辅助装置(cf - lvad)在终末期心力衰竭中的广泛应用,需要熟悉该装置与自然循环的生理相互作用。现代设备主要利用离心流,在较小程度上,轴向流转子,其内在流动特性变化。流量可以通过调整预负荷和后负荷来操纵,就像在原生心脏中一样,并且通过差压-流量(H-Q)曲线或回路来确定预测效果。瓣膜性心脏病,尤其是主动脉反流,可能显著影响机械支持的充分性。相比之下,房室和室室时间的意义则不那么确定。虽然器械治疗的有益效果通常是由于远端灌注增强,左心室和心房的卸载,以及继发性肺动脉高压的改善,但CF-LVAD治疗对右心室充盈和功能的负面影响,通过右侧负荷和间隔相互作用,可以使优化具有挑战性。此外,CF-LVAD治疗所提供的脉动能量的缺乏会对终器官功能产生生理影响,并可能导致一系列不良反应。血管内泵的流变学作用,特别是剪切应力暴露,导致血小板活化和溶血,这可能导致血栓和出血的后果。针对不良设备-循环相互作用的新解决方案的开发将促进血流动力学支持,同时减轻不良事件。©2021美国生理学会。中国生物医学工程学报(英文版),2012。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Physiology of Continuous-Flow Left Ventricular Assist Device Therapy.

The expanding use of continuous-flow left ventricular assist devices (CF-LVADs) for end-stage heart failure warrants familiarity with the physiologic interaction of the device with the native circulation. Contemporary devices utilize predominantly centrifugal flow and, to a lesser extent, axial flow rotors that vary with respect to their intrinsic flow characteristics. Flow can be manipulated with adjustments to preload and afterload as in the native heart, and ascertainment of the predicted effects is provided by differential pressure-flow (H-Q) curves or loops. Valvular heart disease, especially aortic regurgitation, may significantly affect adequacy of mechanical support. In contrast, atrioventricular and ventriculoventricular timing is of less certain significance. Although beneficial effects of device therapy are typically seen due to enhanced distal perfusion, unloading of the left ventricle and atrium, and amelioration of secondary pulmonary hypertension, negative effects of CF-LVAD therapy on right ventricular filling and function, through right-sided loading and septal interaction, can make optimization challenging. Additionally, a lack of pulsatile energy provided by CF-LVAD therapy has physiologic consequences for end-organ function and may be responsible for a series of adverse effects. Rheological effects of intravascular pumps, especially shear stress exposure, result in platelet activation and hemolysis, which may result in both thrombotic and hemorrhagic consequences. Development of novel solutions for untoward device-circulatory interactions will facilitate hemodynamic support while mitigating adverse events. © 2021 American Physiological Society. Compr Physiol 12:1-37, 2021.

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来源期刊
CiteScore
10.50
自引率
0.00%
发文量
38
审稿时长
6-12 weeks
期刊介绍: Comprehensive Physiology is the most authoritative and comprehensive collection of physiology information ever assembled, and uses the most powerful features of review journals and electronic reference works to cover the latest key developments in the field, through the most authoritative articles on the subjects covered. This makes Comprehensive Physiology a valued reference work on the evolving science of physiology for both researchers and clinicians. It also provides a useful teaching tool for instructors and an informative resource for medical students and other students in the life and health sciences.
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