Mechanical Circulatory Support: Response of the Failing Heart to a New Generation of Pumps

Since the REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) clinical trial demonstrated the superiority of long-term mechanical support for end-stage heart failure2 patients have been offered ventricular assist devices (VAD) as a standard therapeutic bridge to cardiac transplantation.1.4 However, expanding indications and greater utilization of mechanical circulatory support has led to the development of smaller and technically varied VADs. As opposed to the currently approved VADs, newer systems provide continuous non-pulsatile circulatory support using impellers in an axial flow system (Figure 1). The purpose of this review is to present the current status and applications of axial flow pumps, as well as to discuss the response of the failing myocardium to continuous flow support.