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Mechanical Blood Trauma in Circulatory-Assist Devices (Hardcover)
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Mechanical Blood Trauma in Circulatory-Assist Devices (Hardcover)
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Mechanical cardiovascular assist devices must be properly designed
to avoid damage to the blood they contact. The factors that affect
the hemocompatibility of a cardiovascular assist device include
three major non-physiological components - the material, fluid flow
paths, and flow related stresses, - as well as the device
interaction with the native vasculature. Furthermore, the
interaction of the device with the blood is not static. Foreign
surfaces activate blood components including platelets, leukocytes
and the coagulation cascade. Thrombus formation on the surface of
the device can alter the fluid dynamics in a manner that causes
erythrocyte damage ranging from significant hemolysis to sub-lethal
trauma that can take many days to weeks to develop into a
significant clinical problem. This sub-lethal blood trauma is not
easily detectable without special equipment, which is typically
unavailable in routine clinical practice. Surveillance for blood
damage is often sub-optimal in the clinical setting, but once
clinically relevant hemolysis occurs, crucial decisions - device
removal, replacement, or additional medical therapies including
surgery or plasmapheresis - that take into account the risk/benefit
of intervention must be quickly evaluated. The various preclinical
designs and testing, surgical considerations, available
surveillance techniques, and clinical consequences will be
discussed using recent and historical case reports to highlight key
points.
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