title: Myocardial Structural and Functional Response After Long-Term Mechanical Unloading With Continuous Flow Left Ventricular Assist Device: Axial Versus Centrifugal Flow.
abstract: The aim of this study was to assess the impact of continuous-flow left ventricular assist device (LVAD) type-axial flow (AX) versus centrifugal flow (CR)-on myocardial structural and functional response following mechanical unloading.
  
  
  
  The use of continuous-flow LVADs is increasing steadily as a therapeutic option for patients with end-stage heart failure who are not responsive to medical therapy. Whether the type of mechanical unloading influences the myocardial response is yet to be determined.
  
  
  
  A total of 133 consecutive patients with end-stage heart failure implanted with continuous-flow LVADs (AX, n = 107 [HeartMate II Thoratec Corporation, Pleasanton, California]; CR, n = 26 [HeartWare, HeartWare International, Framingham, Massachusetts]) were prospectively studied. Echocardiograms were obtained pre-LVAD implantation and then serially at 1, 2, 3, 4, 6, 9, and 12 months post-implantation.
  
  
  
  The 2 pump types led to similar degrees of mechanical unloading as assessed by invasive hemodynamic status and frequency of aortic valve opening. Myocardial structural and functional parameters showed significant improvement post-LVAD in both AX and CR groups. Left ventricular ejection fraction increased significantly from a mean of 18% to 28% and 26% post-LVAD in the AX and CR groups, respectively. Left ventricular end-systolic volume index and left ventricular end-diastolic volume index decreased significantly as early as 30 days post-implantation in the 2 groups. The degree of myocardial structural or functional response between patients in the AX or CR groups appeared to be comparable.
  
  
  
  Long-term mechanical unloading induced by AX and CR LVADs, while operating within their routine clinical range, seems to exert comparable effects on myocardial structural and functional parameters.
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Sarie
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Asad
authors.initials: A
authors.lastname: Rauf
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Anna
authors.initials: A
authors.lastname: Catino
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: James
authors.initials: J
authors.lastname: Wever-Pinzon
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Michael
authors.initials: M
authors.lastname: Bonios
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Diakos
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Omar
authors.initials: O
authors.lastname: Wever-Pinzon
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: McKellar
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Aaron
authors.initials: A
authors.lastname: Kelkhoff
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Lauren
authors.initials: L
authors.lastname: McCreath
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: James
authors.initials: J
authors.lastname: Fang
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah. Electronic address: stavros.drakos@hsc.utah.edu.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D011446:Prospective Studies; D013318:Stroke Volume
keywords: axial versus centrifugal; continuous flow; left ventricular assist device; mechanical unloading; myocardial function; myocardial structure