No abstract

Persons with cardiac syncope are at increased risk for death from any cause and cardiovascular events, and persons with syncope of unknown cause are at increased risk for death from any cause. Vasovagal syncope appears to have a benign prognosis.

A continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplantation, with improved functional status and quality of life. (Thoratec HeartMate II Left Ventricular Assist System [LVAS] for Bridge to Cardiac Transplantation; NCT00121472).

Background-The effects of continuous blood flow and reduced pulsatility on major organ function have not been studied in detail. Methods and Results-We evaluated renal (creatinine and blood urea nitrogen) and hepatic (aspartate transaminase, alanine transaminase, and total bilirubin) function in 309 (235 male, 74 female) advanced heart failure patients who had been supported with the HeartMate II continuous-flow left ventricular assist device for bridge to transplantation. To determine whether patients with impaired renal and hepatic function improve over time with continuous-flow left ventricular assist device support or whether there are any detrimental effects in patients with normal organ function, we divided patients into those with above-normal and normal laboratory values before implantation and measured blood chemistry over time during left ventricular assist device support. There were significant improvements over 6 months in all parameters in the above-normal groups, with values in the normal groups remaining in the normal range over time.Mean blood urea nitrogen and serum creatinine in the above-normal groups decreased significantly from 37Ϯ14 to 23Ϯ10 mg/dL (PϽ0.0001) and from 1.8Ϯ0.4 to 1.4Ϯ0.8 mg/dL (PϽ0.01), respectively. There were decreases in aspartate transaminase and alanine transaminase in the above-normal groups from 121Ϯ206 and 171Ϯ348 to 36Ϯ19 and 31Ϯ22 IU (PϽ0.001), respectively. Total bilirubin for the above-normal group was 2.1Ϯ0.9 mg/dL at baseline; after an acute increase at week 1, it decreased to 0.9Ϯ0.5 mg/dL by 6 months (PϽ0.0001). Both renal and liver values from patients in the normal groups remained normal during support with the left ventricular assist device. Conclusions-The HeartMate II continuous-flow left ventricular assist device improves renal and hepatic function in advanced heart failure patients who are being bridged to transplantation, without evidence of detrimental effects from reduced pulsatility over a 6-month time period. Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00121472.