9: MICA-Antibodies Predict the Risk for Acute and Chronic Rejection after Heart Transplantation

Abstract

Purpose: It has not been shown if continuous flow LVADs can provide adequate support for larger patients as compared to pulsatile flow LVADs, especially in the early postop period. Methods and Materials: We compared LVAD pump flow index (Qi, L/min/m) on days 1 and 30 of support as well as outcomes at 180 days in 133 patients from the continuous flow HeartMate II (HM2) and 280 patients from the pulsatile HeartMate VE (HM1) LVAD trials for bridge to transplantation. Patients were divided into 4 groups based on HM2 quartiles of body surface area (BSA). Results: There were no significant differences in demographics. Median BSA for HM2 patients (1.98 m, range: 1.33-2.62) was similar to HM1 (1.98, range:1.45-2.75). There were no differences in Qi at day 1 between HM2 (2.7 0.5) and HM1 (2.6 0.5) or at day 30 (HM2 (2.9 0.6) and HM1 (2.8 0.5). Qi in each size group increased from day 1 to day 30, and increasing BSA resulted in slightly lower Qi for both devices. There were no significant differences between Qi between HM1 and HM2 in any of the BSA ranges, including the largest patients (BSA 2.2). There was no significant difference in survival to transplant, recovery or ongoing device support at 180 days in all groups. Conclusions: Continuous flow LVADs can provide similar levels of circulatory support even in large patients as compared to pulsatile flow LVADs. The advantages of these newer devices such as small size and superior durability may be extended to larger patients.