Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability have improved with CF-LVADs, patients supported with CF-LVADs have a high rate of complications that were not as frequently observed with older pulsatile devices, including gastrointestinal bleeding from arteriovenous malformations, pump thrombosis, and stroke. Given the apparent fundamental biological role of the pulse, the purpose of this review is to describe the normal physiology of ventricular-arterial coupling from pulsatile flow, the effects of heart failure on this physiology and the vasculature, and to examine the effects of nonpulsatile blood flow on the vascular system and potential role in complications seen with CF-LVAD therapy. Understanding these concomitant vascular changes with CF-LVADs may be a key step in improving patient outcomes as modulation of pulsatility and flow characteristics may serve as a novel, yet simple, therapy for reducing complications.

搏动性似乎具有目的论作用，因为进化层次有利于具有更复杂的多腔循环系统的高级动物，与低级动物相比，它们产生更高的脉压。然而，尽管经过多年的自然选择，在过去十年中越来越多地使用的现代一代连续流左心室辅助装置 (CF-LVAD) 已经创造了一种独特的生理学，其特征是非脉动、非层流血流分布，且不存在舒张期间通常的大弹性动脉 Windkessel 效应。尽管 CF-LVAD 的结果和耐用性得到了改善，但接受 CF-LVAD 支持的患者并发症发生率很高，而使用旧式脉动装置则不会频繁观察到这些并发症，包括动静脉畸形引起的胃肠道出血、泵血栓形成和中风。鉴于脉搏明显的基本生物学作用，本综述的目的是描述脉动血流心室-动脉耦合的正常生理学、心力衰竭对此生理学和脉管系统的影响，并检查非脉动血的影响血管系统血流及其在 CF-LVAD 治疗并发症中的潜在作用。了解 CF-LVAD 伴随的血管变化可能是改善患者预后的关键一步，因为脉动和血流特性的调节可能作为减少并发症的新颖而简单的疗法。