Does continuous flow left ventricular assist device technology have a positive impact on outcome pretransplant and posttransplant?
BACKGROUND
Left ventricular assist devices (LVADs) with continuous flow properties are increasingly used to bridge heart failure patients to cardiac transplantation. Advantages in comparison with the pulsatile LVADs are smaller size, better endurance, and lower thromboembolic events. However, whether these new pumps have similar pre- and posttransplant outcomes is not clear.


METHODS
Fifty patients with a continuous flow device (Micromed DeBakey, Houston, TX or InCor BerlinHeart, Berlin, Germany) were compared with an age-, disease-, and LVAD duration-matched control group (n = 80) supported with a pulsatile device (Novacor, WorldHeart, Oakland, CA or HeartMate, Thoratec Corp, Pleasanton, CA).


RESULTS
Age (44.3 +/- 13.4 vs 46.1 +/- 11.1 years), disease (idiopathic dilated cardiomyopathy, 58% vs 65%), and LVAD duration (138 +/- 131 vs 128 +/- 106 days) were comparable in both groups. Successful bridging to transplantation was similar with continuous flow in comparison with pulsatile device support (52% vs 56%, p = not significant [NS]). Thirty-day mortality after cardiac transplantation in patients with continuous flow LVAD support was 21.7% vs 22.2% with pulsatile LVADs (p = NS). Reasons for death were similar among the different LVAD groups. Long-term survival was similar in both LVAD groups compared with patients without previous LVAD support. Interestingly, severe rejections were significantly more frequent in patients with a continuous flow LVAD (p < 0.001).


CONCLUSIONS
The new generation of cardiac assist devices with continuous flow pattern has a similar rate of pre- and posttransplant mortality in comparison with pulsatile LVADs. However, the rate and severity of posttransplant rejection was significantly higher in the group with continuous flow devices. Further studies are warranted to explain the higher rate of severe rejections.
Klotz
Stefan
S
Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany. stefan.klotz@ukmuenster.de
Stypmann
Joerg
J
Welp
Henryk
H
Schmid
Christof
C
Drees
Gabriele
G
Rukosujew
Andreas
A
Scheld
Hans H
HH
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006352:Heart Ventricles; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D016896:Treatment Outcome