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Successive iterations of continuous left ventricular assist devices (LVADs) have shared a common theme: a fixed pump speed. The exact parameters that should dictate optimal pump speed remain a matter of debate, although various echocardiographic and haemodynamic assessments are used towards this end (table 1).1 2 An obvious shortcoming of any attempt at LVAD pump speed optimisation arises from the fact that the pump speed is set under a single set of conditions. The total systemic output is ultimately a function of the interaction between the LVAD and the native heart, which is dependent on a multitude of variable factors, including right ventricular function, left ventricular contractile reserve pulmonary and systemic vascular resistance, and chronotropic function. The inability to modulate LVAD pump speed in response to varying conditions or the need for greater cardiac output during physiological stress is a limitation of current durable LVADs. If the pump speed is too slow for the given condition, the patient is undersupported, and if it is …
Contributors JK and JP coauthored the submitted editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; externally peer reviewed.