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Left ventricular pressure and volume unloading during pulsatile versus nonpulsatile left ventricular assist device
Stefan Klotz1, Mario C Deng, Joerg Stypmann
1Department of Thoracic and Cardiovascular Surgery, University Hospital, Muenster, Germany. stefan.klotz@thmgs.uni-muenster.de
The Annals of Thoracic Surgery
|January 17, 2004
Summary
Newer nonpulsatile left ventricular assist devices (LVADs) offer similar pressure unloading to pulsatile LVADs. However, pulsatile LVADs provide greater volume unloading for patients with heart failure.
Area of Science:
- Cardiology
- Biomedical Engineering
- Mechanical Circulatory Support
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure.
- Latest LVAD generations utilize nonpulsatile pumps (axial or centrifugal).
- Long-term comparison of LV unloading and outcomes between pulsatile and nonpulsatile LVADs is lacking.
Purpose of the Study:
- To compare left ventricular (LV) pressure and volume unloading between pulsatile and nonpulsatile LVADs.
- To assess the impact of LVAD type on mortality during long-term support.
Main Methods:
- Retrospective analysis of 31 patients with long-term LVAD implantation (10 nonpulsatile, 21 pulsatile).
- Preoperative and postoperative echocardiographic and hemodynamic assessments, including right heart catheterization.
- Comparison of LV pressure and volume unloading, pump output, and transplant mortality.
Main Results:
- Both LVAD types achieved similar LV pressure unloading, indicated by comparable reductions in pulmonary pressures.
- Pulsatile LVADs demonstrated significantly greater LV volume unloading due to higher pump output (5.1 L/min vs. 3.6 L/min).
- LV volume unloading decreased in nonpulsatile LVADs between 60 and 120 days post-implantation; mortality was similar between groups.
Conclusions:
- Nonpulsatile and pulsatile LVADs provide comparable left ventricular pressure unloading.
- Pulsatile LVADs achieve more pronounced left ventricular volume unloading.
- LVAD type influences volume unloading dynamics, but not overall transplant mortality.