title: Neurocognitive function in destination therapy patients receiving continuous-flow vs pulsatile-flow left ventricular assist device support.
abstract: BACKGROUND
  The HeartMate II (Thoratec Corp, Pleasanton, CA) continuous-flow left ventricular assist device (LVAD) improved survival in destination therapy (DT) patients during a randomized trial compared with pulsatile-flow LVADs. This study documented changes in cognitive performance in DT patients from that trial to determine if there were differences between continuous-flow and pulsatile-flow support.
  
  
  METHODS
  Data were collected in a sub-study from 96 HeartMate II continuous-flow and 30 HeartMate XVE pulsatile-flow LVAD patients from 12 of the 35 trial sites that followed the same serial neurocognitive (NC) testing protocol at 1, 3, 6, 12, and 24 months after LVAD implantation. Spatial perception, memory, language, executive functions, and processing speed were the domains assessed with 10 standard cognitive measures. Differences over time and between LVAD type were evaluated with linear mixed-effects modeling.
  
  
  RESULTS
  From 1 to 24 months after LVAD implantation, changes in NC functions were stable or showed improvement in all domains, and there were no differences between the continuous-flow and pulsatile-flow groups. Data at 24 months were only available from patients with the continuous-flow LVAD due to the limited durability of the HeartMate XVE device. There was no decline in any NC domain over the time of LVAD support. Missing data not collected from patients who died could have resulted in a bias toward inflated study results.
  
  
  CONCLUSIONS
  The NC performance of advanced heart failure patients supported with continuous-flow and pulsatile-flow LVADs shows stabilization or improvement during support for up to 24 months.
authors.affiliation: Department of Psychiatry, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA. ralph.petrucci@drexelmed.edu
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Petrucci
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: Laura
authors.initials: L
authors.lastname: Blue
authors.forename: Colleen
authors.initials: C
authors.lastname: Gallagher
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.forename: Dzifa
authors.initials: D
authors.lastname: Dordunoo
authors.forename: Brian E
authors.initials: BE
authors.lastname: Jaski
authors.forename: Suzanne
authors.initials: S
authors.lastname: Chillcott
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sun
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Yanssens
authors.forename: Antone
authors.initials: A
authors.lastname: Tatooles
authors.forename: Lalig
authors.initials: L
authors.lastname: Koundakjian
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrar
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D011474:Prosthesis Design; D016896:Treatment Outcome