Clinical outcome after implantation of pulsatile versus non pulsatile left ventricular assist devices

Abstract

Objective: We analysed the differences in clinical outcome after implantation of pulsatile and non-pulsatile Left Ventricular Assist Devices (LVAD). Methods: Between 01/1998–09/2007 61 patients (age 53±12y, range 16–78y) were treated for acute LV failure with implantation of a LVAD. Two groups were selected according to the type of pump flow: Group I (pulsatile LVAD (n=39) including HeartMate I, Thoratec LVAD, Medos, Novacor) and group II (nonpulsatile LVAD (n=21) including Jarvik 2000, Heartmate II, Ventrassist, Incor). Follow-up parameters were analysed preoperatively and at day 30 after implantation: Creatinine, Bilirubin, GPT, ventilation time, tracheotomy rate and need for dialysis. Results: Duration of support was 212±178d (range 6–681d) in group I and 313±555d (range 5–2403d) in group II. 30-days mortality was 13% (5/39) in group I and 15% (3/21) in group II. Creatinine levels reached pre-op values 30d after LVAD implantation in both groups (1.4±0.6mg/dl, 1.0±0.4mg/dl, respectively). 38% (15/39) had to be dialysed in group I versus 5% (1/21) in group II. There was no difference in ventilatory support (group I: 257±458h, median 48h; group II: 107±197h, median 30h). In group I, 8 pts. (20%) needed reintubation due to respiratory failure versus 6 pts. (31%) in group II. Tracheotomy-rate was higher in group I (20% (8/39) versus 14% (6/21), respectively). Bilirubin-levels were higher in group II 30d after implantation (2.6±5.0 and 1.0±2.8mg/dl, respectively) with no significant difference in GPT values. Conclusion: Clinical outcome after implantation of a nonpulsatile LVAD is similar to that after implantation of a pulsatile LVAD.