Abstract 5854: Serial Assessment of Pulsatile and Non-Pulsatile Left Ventricular Assist Devices on Left Ventricular Unloading

Abstract

Pulsatile and continuous flow left ventricular assist device (LVAD)s combined with pharmacological agents have been used to bridge patients with end-stage dilated cardiomyopathy (DCM) to recovery. The aim of this study was to compare the effects of pulsatile versus continuous flow LVADs on left ventricular (LV) unloading. Unloading was assessed by echocardiography at 1, 3 and 6 months in 50 non-ischaemic DCM patients with LVADs. 29 patients received a pulsatile volume displacement pump (HeartMate XVE (HM I group); Thoratec Corp.) and 21 patients received a continuous-flow rotary pump (HeartMate II (HM II group); Thoratec Corp.). Parameters measured included end-systolic and end-diastolic diameters (ESD and EDD) and ejection fraction (EF). There was no difference in pre-implantation data between the two groups. At 1 month post device implantation, HM I patients showed significantly greater LV unloading compared to HM II patients (ESD 30.6±10, EDD 44±9.7, EF 64.8±14.5 vs 41.5±10.7, 50.9±9.7, 45.5±15.9, respectively), but there was no difference in LV unloading at 3 or 6 months (table 1 ). In the patients recovered with HM I (n=16) there was a lower ESD and higher EF compared to those with HM II (n=7) at 1 month. No difference was seen at 3 or 6 months (table 2 ). HM I XVE provided a better degree of LV unloading compared to HM II at 1 month of LVAD support. At three and six months of LVAD support both devices provided an equivalent degree of LV unloading. Table 1. Comparison of LV unloading between HM I and HM II patients. Table 2. Comparison of LV unloading between HM I and HM II recovered patients