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Published on: May 11, 2018
Long-term continuous flow left ventricular assist device support and end-organ function: prospects for destination
1Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky 40202, USA. mark.slaughter@louisville.edu
Journal of Cardiac Surgery
|July 21, 2010
Summary
Continuous flow left ventricular assist devices (CF-LVADs) adequately support patients with heart failure, maintaining or improving end-organ function. Evidence suggests CF-LVADs provide comparable circulatory support to pulsatile devices for bridge-to-transplant and destination therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Pulsatile flow left ventricular assist devices (PF-LVADs) are established treatments for severe heart failure, improving survival and quality of life.
- Continuous flow left ventricular assist devices (CF-LVADs) are increasingly used, raising questions about their efficacy compared to PF-LVADs.
- End-organ dysfunction reversal is a key benefit of LVAD support, necessitating evaluation of CF-LVADs' impact on these functions.
Purpose of the Study:
- To evaluate the effectiveness of continuous flow left ventricular assist devices (CF-LVADs) in providing circulatory support for patients with severe heart failure.
- To assess the impact of CF-LVADs on end-organ function, including renal, hepatic, and neurocognitive status.
- To compare the functional support provided by CF-LVADs versus pulsatile flow LVADs (PF-LVADs) in bridge-to-transplant and destination therapy contexts.
Main Methods:
- Review of clinical studies and available data on CF-LVAD support.
- Analysis of end-organ function parameters (renal, hepatic, neurocognitive) in patients with CF-LVADs.
- Examination of microcirculation studies related to CF-LVAD support.
Main Results:
- Clinical studies show renal, hepatic, and neurocognitive function are maintained or improved with CF-LVADs for up to 15 months.
- Arterial pulsatility is often present during CF-LVAD support, challenging the "nonpulsatile" designation.
- Microcirculation studies indicate adequate capillary blood flow for cellular function during CF-LVAD support.
- Anecdotal evidence suggests long-term (over 7 years) preserved end-organ function with CF-LVADs.
Conclusions:
- Current clinical evidence supports that CF-LVADs provide adequate end-organ perfusion and function for extended durations.
- CF-LVADs appear to offer comparable circulatory support to PF-LVADs for bridge-to-transplant and destination therapy.
- Further data from ongoing trials will provide more definitive comparisons between CF-LVADs and PF-LVADs.
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