End-organ Function in Patients on Long-term Circulatory Support With Continuous- or Pulsatile-flow Assist Devices

Renal Failure in Patients with Left Ventricular Assist Devices

“…Most of these studies demonstrate either stable to improved renal function after implantation of continuousflow LVADs for periods up to 3.7 years (11,19,(42)(43)(44)(45)(46). In contrast, Hasin et al reported on 83 patients who received a continuous-flow LVAD as either BTT or DT (47).…”

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

“…Sanders et al compared CF-and PF-VAD patients and found comparable improvements from baseline at 12 weeks. Other small studies have confirmed the same up to 15-month follow-up, 15 though the baseline glomerular filtration rate (GFR)-especially in those on PF-VADs-was much better in these studies when compared to the Sanders study. Longer-term…”

“…56 Studies comparing changes between CF-and PF-VADs have not found a significant difference in such improvements. 15 The mechanism of formation of arteriovenous (AV) malformations in the gut is detailed elsewhere, but the role of pulsatility loss and possibly local endothelial factors such as VEGF and vWF in the formation of vascular malformations is not well established. In a single-center study, we did not find any association between the extent of aortic valve opening (as a surrogate marker of pulse pressure) and clinically significant gastrointestinal AV malformations.…”

How Can We Predict Reversibility of Organ Dysfunction After Implantation of Left Ventricular Assist Device?

“…Recently, several investigators reported that continuous flow (CF) LVAD support for extended durations will be as safe and effective in patients with pre-implant multiorgan failure (MOF) as pulsatile flow LVAD. 4, 5 Yoshioka et al reported that the cumulative survival curve after LVAD implantation mainly depends on the existence of renal dysfunction rather than on extracorporeal membrane oxygenation (ECMO) support. 6 Therefore, LVAD implantation should be considered without delay if further deterioration of end-organ dysfunction is noted even with ECMO support.…”