Hemodynamic and Exercise Performance With Pulsatile and Continuous-Flow Left Ventricular Assist Devices

Abstract

Background-Continuous-flow rotary pumps with axial design are increasingly used for left ventricular assist support. The efficacy of this design compared with pulsatile, volume displacement pumps, with respect to characteristics of left ventricular unloading, and exercise performance remains largely unstudied. Methods and Results-Thirty-four patients undergoing implantation with a pulsatile, volume displacement pump operating in a full-to-empty cycle (HeartMate XVE; Thoratec Inc, Pleasanton, Calif; nϭ16) or continuous-flow rotary pump with an axial design operating at a fixed rotor speed (HeartMate II; Thoratec Inc; nϭ18) were evaluated with right heart catheterization and echocardiography preoperatively and at 3 months postoperatively and cardiopulmonary exercise testing 3 months postoperatively.

Imaging for Ventricular Function and Myocardial Recovery on Nonpulsatile Ventricular Assist Devices

“…8 In contrast, other studies report decreased LV unloading in patients receiving continuous-flow LVAD support when LV dimensions/volumes were directly compared with those of patients implanted with pulsatile pumps. 9,10 It is important to recognize that these recent continuous-flow pump studies 5,7,9,10 all assessed LV size at baseline levels of relatively full support. The reported reduction in LV dimensions does not necessarily imply reverse LV remodeling, which is best assessed by decreasing the amount of LVAD support as much as possible while imaging ( Figure 1).…”

Advantage of Pulsatility in Left Ventricular Reverse Remodeling and Aortic Insufficiency Prevention During Left Ventricular Assist Device Treatment

“…7,13,[20][21][22] In this study, the LVEF increased significantly during PF LVAD support compared with CF devices. Although clinical backgrounds were not necessarily matched completely, some authors showed more volume unloading with PF devices, 13,14 while others showed that a PF pump was better than a CF pump considering the improvement in LVEF or explantation in the clinical setting.…”

ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

“…Because the postoperative management of the LVAD and cardiac transplant patient is focused on right ventricular management, the HF specialist should be skilled in the management of right ventricular failure. Compared with successful cardiac transplantation, exercise capacity is less following chronic outpatient mechanical support 56,57 and the patient's daily concerns are typically greater (eg, battery exchange or recharging, driveline maintenance). The HF specialist should be able to interpret the results of exercise testing following LVAD placement and make activity level recommendations.…”