TY - JOUR

T1 - Bionic women and men - Part 1

T2 - Cardiovascular lessons from heart failure patients implanted with left ventricular assist devices

AU - Stöhr, Eric J.

AU - Cornwell, William K.

AU - Kanwar, Manreet

AU - Cockcroft, John R.

AU - McDonnell, Barry J.

N1 - Funding Information: This article is dedicated to Steve Griffith, an LVAD patient from Cardiff in Wales, who is an inspiration to other patients, researchers, clinicians and the general public. Thank you, Steve. The authors thank The Physiological Society for the opportunity to present this symposium at the Society's annual meeting of 2019 in Aberdeen, UK, and for the invitation to write the reports from the meeting in Experiment Physiology. Funding Information: W.K.C. has received funding from Medtronic Inc. M.K. has received Research funding from Abbott Inc., but none relevant to this submission. Funding Information: B.J.M. and E.J.S. received funding from the European Union's Horizon 2020. Their project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska‐Curie grant agreement no. 705219. W.K.C. has received funding by an NIH/NHLBI Mentored Patient‐33 Oriented Research Career Development Award (No. 1K23HLI32048‐01), as well as the 34 NIH/NCATS (No. UL1TR002535), Susie and Kurt Lochmiller Distinguished Heart Transplant 35 Fund, the Clinical Translational Science Institute at the University of Colorado Anschutz 36 Medical Campus, and Medtronic Inc.

PY - 2020/5/1

Y1 - 2020/5/1

N2 - New Findings: What is the topic of this review? Patients with advanced heart failure who are implanted with left ventricular assist devices (LVADs) present an opportunity to understand the human circulation under extreme conditions. What advances does it highlight? LVAD patients have a unique circulation that is characterized by a reduced or even absent arterial pulse. The remarkable survival of these patients is accompanied by circulatory complications, including stroke, gastrointestinal bleeding and right-heart failure. Understanding the mechanisms related to the complications in LVAD patients will help the patients and also advance our fundamental understanding of the human circulation in general. Abstract: Some humans with chronic, advanced heart failure are surgically implanted with a left ventricular assist device (LVAD). Because the LVAD produces a continuous flow, a palpable pulse is often absent in these patients. This allows for a unique investigation of the human circulation and has created a controversy around the ‘need’ for a pulse. The medical debate has also generated a more generic, fundamental discussion into what is ‘normal’ arterial physiology and health. The comprehensive study and understanding of the arterial responses to drastically altered haemodynamics due to continuous-flow LVADs, at rest and during activity, presents an opportunity to significantly increase our current understanding of the fundamental components of arterial regulation (flow, blood pressure, sympathetic activity, endothelial function, pulsatility) in a way that could never have been studied previously. In a series of four articles, we summarize the talks presented at the symposium entitled ‘Bionic women and men – Physiology lessons from implantable cardiac devices’ presented at the 2019 Annual Meeting of The Physiological Society in Aberdeen, UK. The articles highlight the novel questions generated by physiological phenomena observed in LVAD patients and propose future areas of interest within the field of cardiovascular physiology.

AB - New Findings: What is the topic of this review? Patients with advanced heart failure who are implanted with left ventricular assist devices (LVADs) present an opportunity to understand the human circulation under extreme conditions. What advances does it highlight? LVAD patients have a unique circulation that is characterized by a reduced or even absent arterial pulse. The remarkable survival of these patients is accompanied by circulatory complications, including stroke, gastrointestinal bleeding and right-heart failure. Understanding the mechanisms related to the complications in LVAD patients will help the patients and also advance our fundamental understanding of the human circulation in general. Abstract: Some humans with chronic, advanced heart failure are surgically implanted with a left ventricular assist device (LVAD). Because the LVAD produces a continuous flow, a palpable pulse is often absent in these patients. This allows for a unique investigation of the human circulation and has created a controversy around the ‘need’ for a pulse. The medical debate has also generated a more generic, fundamental discussion into what is ‘normal’ arterial physiology and health. The comprehensive study and understanding of the arterial responses to drastically altered haemodynamics due to continuous-flow LVADs, at rest and during activity, presents an opportunity to significantly increase our current understanding of the fundamental components of arterial regulation (flow, blood pressure, sympathetic activity, endothelial function, pulsatility) in a way that could never have been studied previously. In a series of four articles, we summarize the talks presented at the symposium entitled ‘Bionic women and men – Physiology lessons from implantable cardiac devices’ presented at the 2019 Annual Meeting of The Physiological Society in Aberdeen, UK. The articles highlight the novel questions generated by physiological phenomena observed in LVAD patients and propose future areas of interest within the field of cardiovascular physiology.

KW - arterial function

KW - bionic

KW - heart failure

KW - LVAD

KW - mechanical circulatory support

UR - http://www.scopus.com/inward/record.url?scp=85083069360&partnerID=8YFLogxK

U2 - 10.1113/EP088323

DO - 10.1113/EP088323

M3 - Article

C2 - 32104940

AN - SCOPUS:85083069360

VL - 105

SP - 749

EP - 754

JO - Experimental physiology

JF - Experimental physiology

SN - 0958-0670

IS - 5

ER -