title: Functional and haemodynamic recovery after implantation of continuous-flow left ventricular assist devices in comparison with pulsatile left ventricular assist devices in patients with end-stage heart failure.
abstract: OBJECTIVE
  Caused by ageing of the population, better survival from ischaemic heart disease, and improved treatment of chronic heart disease, the incidence of heart failure has increased enormously. Worldwide, left ventricular assist devices (LVADs) are increasingly being used as a bridge or alternative to heart transplantation. In this study, we investigated whether there is difference in functional and haemodynamic recovery after implantation of pulsatile and continuous-flow pumps.
  
  
  RESULTS
  We compared laboratory and echocardiographic data and exercise performance in patients with end-stage heart failure, before and 3 months after implantation of pulsatile and continuous-flow LVADs. A significant improvement in all laboratory parameters after implantation of both types of LVADs was seen, as well as a significant decrease in heart rate and LV dimensions, indicating better haemodynamics and cardiac recompensation. This improvement was better for the pulsatile device, probably due to higher plasma levels and higher LV dimensions before implantation. Exercise capacity strongly improved: 3 months after implantation of pulsatile and continuous-flow LVADs, peak VO(2) was 20.2 ± 4.8 vs. 18.3 ± 4.8 mL/kg/min (P = 0.09) (53 ± 12 vs. 49 ± 11% of predicted for age and gender) (P = 0.28).
  
  
  CONCLUSIONS
  Pulsatile and continuous-flow LVADs result in extensive haemodynamic recovery and exercise performance compatible with daily life activities. Exercise performance with continuous-flow LVADs is equal to that with pulsatile devices. This, in combination with improved survival of the newer devices, allows its use as an alternative to heart transplantation in selected patients.
authors.affiliation: Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands. Pruijsten@yahoo.com
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Pruijsten
authors.forename: Sjoukje I
authors.initials: SI
authors.lastname: Lok
authors.forename: Hans H
authors.initials: HH
authors.lastname: Kirkels
authors.forename: Corinne
authors.initials: C
authors.lastname: Klöpping
authors.forename: Jaap R
authors.initials: JR
authors.lastname: Lahpor
authors.forename: Nicolaas
authors.initials: N
authors.lastname: de Jonge
mesh_terms: D000328:Adult; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D015994:Incidence; D008297:Male; D010101:Oxygen Consumption; D013223:Statistics as Topic; D013997:Time Factors; D014463:Ultrasonography