Over the past 2 decades, there has been a significant increase in the utilization of long-term mechanical circulatory support (MCS) for the treatment of cardiac failure. Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) have been developed in parallel to serve as bridge-to-transplant and destination therapy solutions. Despite the distinct hemodynamic characteristics introduced by LVADs and TAHs, a comparative evaluation of these devices regarding potential complications in supported patients, has not been undertaken. Such a study could provide valuable insights into the complications associated with these devices. Although MCS has shown substantial clinical benefits, significant complications related to hemocompatibility persist, including thrombosis, recurrent bleeding, and cerebrovascular accidents. This review focuses on the current understanding of hemostasis, specifically thrombotic and bleeding complications, and explores the influence of different shear stress regimens in long-term MCS. Furthermore, the role of endothelial cells in protecting against hemocompatibility-related complications of MCS is discussed. We also compared the diverse mechanisms contributing to the occurrence of hemocompatibility-related complications in currently used LVADs and TAHs. By applying the existing knowledge, we present, for the first time, a comprehensive comparison between long-term MCS options.
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REVIEW ARTICLE|
February 22, 2024
Hemocompatibility and biophysical interface of left ventricular assist devices and total artificial hearts
Angelo Nascimbene,
Angelo Nascimbene
1Advanced Cardiopulmonary Therapies and Transplantation, University of Texas, Houston, TX
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David Bark,
David Bark
2Division of Hematology and Oncology, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
3Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
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David M. Smadja
David M. Smadja
4Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
5Hematology Department, Assistance Publique–Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France
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Blood (2024) 143 (8): 661–672.
Article history
Submitted:
January 30, 2023
Accepted:
September 20, 2023
First Edition:
October 27, 2023
Citation
Angelo Nascimbene, David Bark, David M. Smadja; Hemocompatibility and biophysical interface of left ventricular assist devices and total artificial hearts. Blood 2024; 143 (8): 661–672. doi: https://doi.org/10.1182/blood.2022018096
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February 22 2024
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