Importance of pulsatility in left ventricular assist device

A left ventricular assist device (LVAD) can improve the quality of life and mortality in those patients. Continuous-flow LVAD has unique physiology characterized by a non-(or weak-) pulsatile and non-laminar blood flow profile without the Wind-Kessel effect during diastole. Unfortunately, many LVAD-related adverse events are associated with long-term mortality in patients with the current generation of LVADs, even in the current Heartmate 3 era. In addition, LVAD patients without pulsatility have a high incidence of hemocompatibility complications, including gastrointestinal bleeding, pump thrombosis, and stroke. From the point of view of clinical hemorheology, this review covers the clinical importance of pulsatility and hemocompatibility-related adverse events associated with a reduction in pulsatility in patients with LVAD. Understanding these hemodynamic changes with LVADs may provide clinical pearls for improving patients' outcomes. Indeed, the modulation of pulsatility may serve as a novel strategy for reducing complications.