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Ann Thorac Surg 2007;83:1082-1088
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Clinical Outcomes Are Similar in Pulsatile and Nonpulsatile Left Ventricular Assist Device Recipients

Erika D. Feller, MDa,*, Erik N. Sorensen, PhDb, Michel Haddad, MDc, Richard N. Pierson, MDc, Frances L. Johnson, MDa, James M. Brown, MDc, Bartley P. Griffith, MDc

a Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland
b Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, Maryland
c Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland

Accepted for publication October 16, 2006.

* Address correspondence to Dr Feller, Division of Cardiology, University of Maryland Medical Center, 22 S Greene St, S3B08, Baltimore, MD 21201 (Email: efeller{at}medicine.umaryland.edu).

Presented at the Poster Session of the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

Background: Despite concerns about the adequacy of support provided by continuous-flow left ventricular assist devices (LVADs), direct comparisons of patient characteristics and outcomes between first-generation pulsatile and second-generation nonpulsatile LVADs are absent. We hypothesized that a nonpulsatile Jarvik 2000 LVAD (Jarvik Heart, Inc, New York, NY) would result in comparable outcomes to those of similarly ill patients implanted with a pulsatile LVAD (Novacor, WorldHeart Inc, Oakland, CA; and HeartMate XVE, Thoratec, Pleasanton, CA).

Methods: We retrospectively compared common pre-LVAD clinical characteristics and indicators of heart failure severity between 13 pulsatile and 14 nonpulsatile LVAD recipients. The outcomes analyzed were either heart transplantation, if the LVAD was intended as a bridge to transplantation, or hospital discharge if the intention was destination therapy.

Results: There was no significant difference between groups in pre-LVAD disease severity indicators. Nonpulsatile LVAD recipients had a significantly smaller body surface area (1.9 ± 0.2 m2 versus 2.1 ± 0.2 m2, p = 0.04) and cardiopulmonary bypass time was also significantly shorter (61 ± 34 minutes versus 110 ± 49 minutes, p = 0.01). Aside from duration of initial intensive care unit stay (nonpulsatile, 10 ± 16 days; pulsatile, 14 ± 11 days; p = 0.02), there was no difference in post-LVAD outcomes: 10 of 14 nonpulsatile and 8 of 13 pulsatile LVAD patients achieved the combined end point (p = 0.69).

Conclusions: Similarly ill congestive heart failure patients benefited equally well from either a nonpulsatile or a pulsatile LVAD. This may support an expanded role for nonpulsatile LVADs in the treatment of severe heart failure.




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