Hemodynamics of Mechanical Circulatory Support

• Published in: Journal of the American College of Cardiology Vol. 66; no. 23; pp. 2663 - 2674
• Main Authors: Burkhoff, Daniel, MD, PhD, Sayer, Gabriel, MD, Doshi, Darshan, MD, Uriel, Nir, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.12.2015; Elsevier Limited
• Subjects: Assisted Circulation - instrumentation; Assisted Circulation - methods; Blood pressure; cardiac index; Cardiac Output; Cardiology; Cardiovascular; central venous pressure; extracorporeal circulatory membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Heart failure; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart Failure - surgery; Heart rate; Heart-Assist Devices; Hemodynamics; Humans; Internal Medicine; Mechanics; Patients; Pulmonary arteries; pulmonary capillary wedge pressure; Treatment Outcome; ventricular assist devices; LV; LVAD; EDP; right ventricle/ventricular; end-diastolic pressure; EDV; pressure–volume area; ventricular assist devices; extracorporeal circulatory membrane oxygenation; volume–axis intercept; cardiac index; PCWP; myocardial oxygen consumption; central venous pressure; RA; Ees; end-systolic elastance; total peripheral resistance; CVP; Ea; MAP; MVO 2; end-systolic pressure–volume relationship; ventricular end-systolic pressure; RV; rotations per minute; mechanical circulatory support; pulmonary artery catheter; RPM; cardiac output; effective arterial elastance; TPR; right atrial/atrium; Vo; extracorporeal membrane oxygenation; end-diastolic volume; left ventricle/ventricular; left atrial/atrium; ECMO; EDPVR; SV; mean arterial pressure; pulmonary capillary wedge pressure; ESPVR; stroke volume; PAC; LA; PVA; left ventricular assist device; MCS; end-diastolic pressure–volume relationship; Pes; MVO2
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.10.017

Abstract An increasing number of devices can provide mechanical circulatory support (MCS) to patients with acute hemodynamic compromise and chronic end-stage heart failure. These devices work by different pumping mechanisms, have various flow capacities, are inserted by different techniques, and have different sites from which blood is withdrawn and returned to the body. These factors result in different primary hemodynamic effects and secondary responses of the body. However, these are not generally taken into account when choosing a device for a particular patient or while managing a patient undergoing MCS. In this review, we discuss fundamental principles of cardiac, vascular, and pump mechanics and illustrate how they provide a broad foundation for understanding the complex interactions between the heart, vasculature, and device, and how they may help guide future research to improve patient outcomes.