Blood Flow Pulsatility in LVAD Patients is essential to Maintain Normal Brain Physiology
Stöhr, Eric J.
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For the first time in history, some humans live without a palpable pulse (Purohitet al., 2018). This 65remarkable physiology is the consequence of surgical implantation of a continuous-flow left 66ventricular assist device (CF-LVAD) in patients with end-stage heart failure.Blood flow produced 67by CF-LVADs has a low oscillatory profile in the aortathat results insignificantly reduced 68pulsatilityin all arterial compartments(Castagnaet al., 2017, Figure 1A and 1B).Despite 69remarkable gains in quality of life and longevity, complications that affect not only morbidity such 70as gastrointestinal bleeding, but also mortality such as strokes,arestill prevalent inCF-LVAD 71patients. Lowpulsatility has been proposedas a major culprit in contributingto these adverse 72events(Mancini & Colombo, 2015;Goldsteinet al., 2018).In this CrossTalk, we presentthe 73current arguments in favour of maintaining an appropriate amount of arterial pulsatility, in 74particular in the cerebral circulation, to lower risk in these patients