Evaluation of healing process and biocompatibility in artificial organs

从体外辅助、植入式辅助和经皮辅助三种不同的辅助方式综述了旋转式血泵的现状和发展前景。对于副心脏手术模式，由于成本效益较小，离心泵在美国的心脏直视手术中的使用已经开始下降。在这个“成本重于质量”的时代，要扭转这一趋势，为其最大的市场保留离心泵，进一步降低成本，有意扩大临床应用，并开发具有革命性概念的“微创心肺系统”，是重要的。对于使用氧合器的体外静脉-动脉搭桥术，两周的泵就足够了，因为辅助模式本身存在根本问题，如左心减压不充分以及与氧合器或经皮插管相关的并发症。对于植入式泵，旋转式血泵确实比脉动泵有许多吸引人的优点，如紧凑、较低的开发和制造成本以及易于植入程序。然而，没有人非常确定现在非脉搏对人类的病理生理影响是什么。在休克的最初恢复期或脑或肾脏有明显动脉粥样硬化的患者中，脉动血流可能是强制性的。泵流量的调节可能是另一个需要研究的问题。我们必须承认，与已经在数千名患者中使用的各种脉动植入式泵存在着激烈的竞争。对于旋转式血泵来说，经皮途径可能是最有吸引力但也最被忽视的领域。为了弥补主动脉内球囊反搏和植入性反搏之间的巨大差距，我们应该开发一种安全可靠的经皮左心辅助泵，这是脉动泵所不能做到的。

The current situation and future perspectives of rotary blood pumps were overviewed from the standpoint of three different assist modes : paracorporeal, implantable, and percutaneous. For the paracorporeal mode, the use of the centrifugal pump in open-heart surgery has begun to decline in the United States because of the small cost benefit. To reverse this trend and save the centrifugal pump for its largest market in this era of "cost matters more than quality, " further cost reduction along with intentional expansion of the clinical applications and the development of a "minimally invasive cardiopulmonary system, " with a revolutionary concept, are important. As for paracorporeal venoarterial bypass with an oxygenator, a two-week pump is sufficient because the assist mode itself has essential problems, such as inadequate left heart decompression and morbidity associated with the oxygenator or percutaneous cannula. For implantable pumps, it is true that rotary blood pumps have many attractive advantages over pulsatile pumps, such as compactness, lower developmental and manufacturing costs and ease of the implantation procedure. However, no one is quite sure what the pathophysiological effects of non-pulsatile now are on humans. Pulsatile flow may be mandatory during the initial recovery period from shock or in patients with significant atherosclerosis of the brain or kidneys. The regulation of the pump flow may be another point to be investigated. We have to admit there is strong competition with the various pulsatile implantable pumps that have already been used in thousands of patients. The percutaneous approach may be the most attractive, yet most neglected, field for rotary blood pumps. To cover the wide gap between the intraaortic balloon pump and implantable pumps, we should develop a safe and reliable percutaneous left ventricular assist pump, which is impossible with a pulsatile pump.