Assisted Circulation Overview

Principles

Definition

Assisted circulation is a multidisciplinary field of research and clinical practice focused on the development and application of mechanical support devices designed to augment or replace the pumping function of a failing heart or circulatory system. This concept investigates the physiological effects of circulatory support, device biomechanics, clinical indications, and patient outcomes, aiming to improve survival and quality of life for individuals with severe cardiovascular dysfunction.

Ontological type

Clinical Indications

Core Technologies

Physiological Effects

Key developments

Key Figures

Hemodynamic Engineering era

Michael DeBakey's team advanced extracorporeal circulation with roller pumps, improved oxygenators, and integrated perfusion protocols that supported pulsatile flow and myocardial protection. John W. Gibbon Jr. provided foundational heart-lung machine concepts that informed later energy-based hemodynamic modeling and flow-trajectory optimization in perfusion practice. Adrian Kantrowitz pioneered early mechanical circulatory support, including intra-aortic balloon pumping and initial ventricular assist concepts linked to real-time hemodynamic targets. Robert Jarvik's Jarvik-7 total artificial heart in 1982 epitomized the era's translational advance, with Denton Cooley and Norman Shumway also driving standardized perioperative circuits and transplant-oriented device development.

Durable Ventricular Support era

Donna Mancini [1] is a leading figure of the Durable Ventricular Support era, with affiliations spanning Baylor College of Medicine [3] and the University of Pennsylvania [4]. Her contribution, exemplified by the 1998 paper Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure [7], highlighted the limited myocardial recovery after LVADs and underscored the necessity for durable devices and robust bridge-to-transplant pathways during this era. D. Craig Miller [2] conducted work at Harvard University [5] and the University of California, San Francisco [6] in this period, as reflected in the 1994 paper Alterations in left ventricular twist mechanics with inotropic stimulation and volume loading in human subjects [8]. This LV twist mechanics work [8] advanced understanding of how inotropic states and loading conditions affect ventricular performance, informing device design, patient management, and the development of multidisciplinary care pathways essential to durable LVAD programs.

Integrated Hybrid Support era

Nader Moazami [1] is a leading clinician-scientist affiliated with Washington University in St. Louis [3] and Icahn School of Medicine at Mount Sinai [4], active across a period of integrated circulatory support advancements. His contributions include Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist Device [8], the 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support [7], and insights into the Mechanism of Self-Regulation and In Vivo Performance of the Cleveland Clinic Continuous‑Flow Total Artificial Heart [9], which advanced real-time control, standardization, and device self-regulation crucial for unified hybrid systems. Francis D. Pagani [2] is a distinguished investigator linked with Harvard University [5] and University of Pennsylvania [6], reflecting cross-institutional leadership in the same period. Pagani's contributions center on shaping guidelines and advancing continuous-flow approaches through the 2013 ISHLT Guidelines [7] and Extended Mechanical Circulatory Support With a Continuous-Flow Rotary LVAD [8], fostering standardized practice and broader adoption in integrated hybrid circulatory support.