Comparison of Cardiac Reverse Remodeling between Older and Newer Generation Continuous-Flow LVAD

Abstract

<h3>Purpose</h3> The purpose of our study is to compare the left ventricular (LV) functional and structural changes following mechanical circulatory support (MCS) between continuous-flow left ventricular assist devices (CF-LVADs) that provide mechanical unloading characterized by specific bioengineering differences. <h3>Methods</h3> The study enrolled 311 chronic HF patients undergoing MCS with HVAD (HW, hybrid levitation centrifugal pump, n=95), HeartMate 3 (HM3, full magnetic levitation centrifugal pump, n=140), and HeartMate II (HM2, axial flow pump, n=76) at four sites across the US. Echocardiographic parameters of LV structure and function were obtained pre-implant and at 1, 3, 6, and 12 months of CF-LVAD support. <h3>Results</h3> There were no significant differences in baseline characteristics between groups. At 3 months post-LVAD support the LV ejection fraction (LVEF) was higher (p=0.03, Figure 1A) and left ventricular end diastolic diameter (LVEDD) was lower (p=0.04, Figure 1B) in HMII patients, but there were no significant difference in LVEF and LVEDD between devices at 6 or 12 months. The proportion of patients achieving "cardiac reverse remodeling responder" status (defined as improvement of LVEF to ≥40% and LVEDD <6.0cm) was 9.32%, and comparable between the CF-LVADs. <h3>Conclusion</h3> The newest generation full magnetically levitated CF-LVAD results in similar cardiac reverse remodeling as older generation CF-LVADs. These findings suggest that the fully magnetically levitated device technology could provide an adequate platform to further study and promote reverse cardiac remodeling clinically.