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Review
. 2023 Mar 2;11(3):757.
doi: 10.3390/biomedicines11030757.

Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice

Fouad Khalil  1 , Rabea Asleh  2   3 , Radha Kanneganti Perue  4 , Jean-Marc Weinstein  5   6 , Adam Solomon  5 , Batya Betesh-Abay  5 , Alexandros Briasoulis  7 , Hilmi Alnsasra  3   5   6
Affiliations
Review

Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice

Fouad Khalil et al. Biomedicines. .

Abstract

Left ventricular assist devices (LVADs) have been increasingly used in patients with advanced heart failure, either as a destination therapy or as a bridge to heart transplant. Continuous flow (CF) LVADs have revolutionized advanced heart failure treatment. However, significant vascular pathology and complications have been linked to their use. While the newer CF-LVAD generations have led to a reduction in some vascular complications such as stroke, no major improvement was noticed in the rate of other vascular complications such as gastrointestinal bleeding. This review attempts to provide a comprehensive summary of the effects of CF-LVAD on vasculature, including pathophysiology, clinical implications, and future directions.

Keywords: continuous flow left ventricular assist device; coronary artery disease; gastrointestinal bleeding; peripheral artery disease; pulmonary hypertension; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pathophysiology of stroke in patients supported with CF-LVAD. Continuous flow and shear stress are the main contributors to the development of cerebrovascular pathology, while infection and hypertension are important risk factors. PDE5i: phosphodiesterase 5 inhibitors; SM: smooth muscle; VWF: von Willebrand Factor.
Figure 2
Figure 2
Pathophysiology of GIB in patients supported with CF-LVAD. VWF deficiency is the common pathway for development of angiodysplasia due to the high shear stress and continuous flow. eNOS: endothelial nitric oxide synthase; GI: gastrointestinal; HMW VWF: high molecular weight von Willebrand Factor; pEVs: platelet-derived extracellular vesicles.
Figure 3
Figure 3
LVAD effect on pulmonary vasculature. Reduction in PVR increases heart transplant probability while persistent PVR elevation is associated with RV failure. ERA: endothelin receptor antagonists; LV: left ventricle; LVAD: left ventricular assist device; PDE5i: phosphodiesterase 5 inhibitors; PVR: pulmonary vascular resistance; RV: right ventricle.
See this image and copyright information in PMC

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