title: Comparison of continuous-flow and pulsatile-flow blood pumps on reducing pulmonary artery pressure in patients with fixed pulmonary hypertension.
abstract: Pulmonary hypertension (PH) is considered as a risk factor for morbidity and mortality in patients undergoing heart transplantation. Recently, left ventricular assist device (LVAD) implantation has been increasingly used in reducing pulmonary artery pressure (PAP) in patients with PH unresponsive to medical therapy. Herein, we aimed to compare the efficacy of continuous-flow and pulsatile-flow blood pumps on the improvement of PH in mechanical circulatory support patients. Twenty-seven patients with end-stage heart failure who underwent LVAD implantation surgery were enrolled. Fifteen of them (55.6%) had continuous-flow pump (HeartWare Ventricular Assist System, HeartWare, Inc., Miramar, FL, USA), and 12 of them (44.4%) had pulsatile pump (Berlin Heart EXCOR ventricular assist device, Berlin Heart AG, Berlin, Germany). The efficacy of LVADs on the improvement of PH was compared between continuous-flow and pulsatile pumps by the evaluation of systolic PAP, tricuspid annular plane systolic excursion (TAPSE), right ventricular systolic motion (RVSM), right ventricular ejection fraction (RVEF), and grade of tricuspid insufficiency (TI) for each of the study participants. All of the 15 patients who underwent continuous-flow blood pump implantation surgery (Group 1) were male with a mean age of 46.9 ± 11.7 years, and in pulsatile-flow blood pump implanted participants (Group 2), the mean age was 40.6 ± 16.8 years, all of whom were also male (P=0.259). Mean follow-up was 313.7 ± 241.3 days in Group 1 and 448.7 ± 120.7 days in Group 2 (P=0.139). In Group 1, mean preoperative and postoperative systolic PAP were measured as 51.7 ± 12.2 mm Hg and 22.2 ± 3.4 mm Hg, respectively, while those in Group 2 were 54.5 ± 7.5 mm Hg and 33.9 ± 6.4 mm Hg, respectively. A significantly greater decrease in systolic PAP was noticed in patients with continuous-flow blood pumps (P=0.023); however, no statistically significant difference was found when we considered the change in TAPSE between study groups (P=0.112). A statistical significance in the alteration of RVEF, RVSM, and the grade of TI during study visits was not found between the study groups (P=0.472, P=0.887, and P=0.237, respectively). Although the two studied types of LVADs were found to be effective in reducing PAP in heart transplantation candidates with PH, lesser postoperative systolic PAP values were achieved in patients who underwent continuous-flow pump implantation surgery.
authors.affiliation: Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey.
authors.forename: Pelin
authors.initials: P
authors.lastname: Ozturk
authors.forename: Aysen Yaprak
authors.initials: AY
authors.lastname: Engin
authors.forename: Sanem
authors.initials: S
authors.lastname: Nalbantgil
authors.forename: Emrah
authors.initials: E
authors.lastname: Oguz
authors.forename: Fatih
authors.initials: F
authors.lastname: Ayik
authors.forename: Cagatay
authors.initials: C
authors.lastname: Engin
authors.forename: Tahir
authors.initials: T
authors.lastname: Yagdi
authors.forename: Sinan
authors.initials: S
authors.lastname: Erkul
authors.forename: Ozlem
authors.initials: O
authors.lastname: Balcioglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozbaran
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: Heart failure; Left ventricular assist device; Pulmonary artery pressure; Pulmonary hypertension