Clinical outcomes are similar in pulsatile and nonpulsatile left ventricular assist device recipients.
BACKGROUND
Despite concerns about the adequacy of support provided by continuous-flow left ventricular assist devices (LVADs), direct comparisons of patient characteristics and outcomes between first-generation pulsatile and second-generation nonpulsatile LVADs are absent. We hypothesized that a nonpulsatile Jarvik 2000 LVAD (Jarvik Heart, Inc, New York, NY) would result in comparable outcomes to those of similarly ill patients implanted with a pulsatile LVAD (Novacor, WorldHeart Inc, Oakland, CA; and HeartMate XVE, Thoratec, Pleasanton, CA).


METHODS
We retrospectively compared common pre-LVAD clinical characteristics and indicators of heart failure severity between 13 pulsatile and 14 nonpulsatile LVAD recipients. The outcomes analyzed were either heart transplantation, if the LVAD was intended as a bridge to transplantation, or hospital discharge if the intention was destination therapy.


RESULTS
There was no significant difference between groups in pre-LVAD disease severity indicators. Nonpulsatile LVAD recipients had a significantly smaller body surface area (1.9 +/- 0.2 m2 versus 2.1 +/- 0.2 m2, p = 0.04) and cardiopulmonary bypass time was also significantly shorter (61 +/- 34 minutes versus 110 +/- 49 minutes, p = 0.01). Aside from duration of initial intensive care unit stay (nonpulsatile, 10 +/- 16 days; pulsatile, 14 +/- 11 days; p = 0.02), there was no difference in post-LVAD outcomes: 10 of 14 nonpulsatile and 8 of 13 pulsatile LVAD patients achieved the combined end point (p = 0.69).


CONCLUSIONS
Similarly ill congestive heart failure patients benefited equally well from either a nonpulsatile or a pulsatile LVAD. This may support an expanded role for nonpulsatile LVADs in the treatment of severe heart failure.
Feller
Erika D
ED
Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. efeller@medicine.umaryland.edu
Sorensen
Erik N
EN
Haddad
Michel
M
Pierson
Richard N
RN
Johnson
Frances L
FL
Brown
James M
JM
Griffith
Bartley P
BP
D000293:Adolescent; D000328:Adult; D000368:Aged; D001830:Body Surface Area; D002315:Cardiopulmonary Bypass; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome