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Clinical outcome and bridge to transplant rate of left ventricular assist device recipient patients: comparison between continuous-flow and pulsatile-flow devices

^a Department of Cardiovascular Disease ‘E. Malan’, Cardiac Surgery Unit, Policlinico S. Donato Hospital, Via Morandi 30, S. Donato Milanese, Milan, Italy
^b Departments of Cardiology and Cardiac Surgery ‘A. DeGasperis’, Niguarda Ca’Granda Hospital, Milan, Italy

Received 18 September 2007; received in revised form 14 February 2008; accepted 15 February 2008.

^_* Corresponding author. Tel.: +39 02 52774393. (Email: agaratti{at}tiscali.it).

Background: Long-term implantable continuous axial-flow pumps are increasingly used in bridging heart failure patients to heart transplant. Compared to pulsatile left ventricular assist devices (LVADs), they offer smaller dimensions, less surgical trauma and less thromboembolisms. However concerns still remain about the long-term effects of continuous-flow on patients’ outcome. The aim of this study was to review our mechanical bridge to transplant experience to compare pre- and post-transplant outcomes between pulsatile and continuous-flow LVAD recipients. Methods: Thirty-six patients with a continuous-flow device (Micromed DeBakey, Houston, TX or InCor Berlin Heart, Berlin, Germany – group A) were compared with 41 patients supported with a pulsatile device (Novacor^®, WorldHeart, Oakland, CA – group B). Results: Mean age (48.6 ± 12.4 vs 47.2 ± 12.5) and LVAD duration (119.3 ± 115.4 vs 128.3 ± 198.3) were similar in the two groups. Group A recipients were smaller compared to group B (mean body surface area = 1.77 ± 0.18 vs 1.93 ± 0.16; p < 0.001). Idiopathic dilated cardiomyopathy was not significantly greater between the two groups (78% vs 58.3%; p = 0.085). Successful bridging to transplantation was similar in group A compared to group B (52.8% vs 63.4%; p = non significant). On-VAD mortality was similar between the two groups (A vs B = 33.3% vs 36.6%; p = non significant). Thirty-day mortality after HTx in group A was 10.5% compared to 7.7% in group B (p = non significant). First year post-transplant incidence of treated rejections (36.8% vs 46%; p = non significant) as the mean number of rejection/patient (0.38 ± 0.5 vs 0.53 ± 0.83; p = non significant) were similar in group A compared to group B. Conclusions: In our experience, when compared to pulsatile LVAD, continuous-flow pumps are similarly effective in transplant rate and post-transplant outcome.

Key Words: Left ventricular assist devices • Heart transplantation • Chronic post-transplant rejection • Multi-organ failure syndrome