Author + information
- Received September 23, 2015
- Revision received February 16, 2016
- Accepted February 19, 2016
- Published online July 1, 2016.
- Mohammad Al-Sarie, MD,
- Asad Rauf, BS,
- Abdallah G. Kfoury, MD,
- Anna Catino, MD,
- James Wever-Pinzon, MD,
- Michael Bonios, MD, PhD,
- Benjamin D. Horne, PhD,
- Nikolaos A. Diakos, MD,
- Omar Wever-Pinzon, MD,
- Stephen H. McKellar, MD, MS,
- Aaron Kelkhoff, MD,
- Lauren McCreath,
- James Fang, MD,
- Josef Stehlik, MD, MPH,
- Craig H. Selzman, MD and
- Stavros G. Drakos, MD, PhD∗ ()
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah
- ↵∗Reprint requests and correspondence:
Dr. Stavros G. Drakos, Cardiac Mechanical Support Program, Division of Cardiovascular Medicine, University of Utah, 30 North 1900 East, Room 4A150, Salt Lake City, Utah 84132.
Objectives The aim of this study was to assess the impact of continuous-flow left ventricular assist device (LVAD) type—axial flow (AX) versus centrifugal flow (CR)—on myocardial structural and functional response following mechanical unloading.
Background The use of continuous-flow LVADs is increasing steadily as a therapeutic option for patients with end-stage heart failure who are not responsive to medical therapy. Whether the type of mechanical unloading influences the myocardial response is yet to be determined.
Methods A total of 133 consecutive patients with end-stage heart failure implanted with continuous-flow LVADs (AX, n = 107 [HeartMate II Thoratec Corporation, Pleasanton, California]; CR, n = 26 [HeartWare, HeartWare International, Framingham, Massachusetts]) were prospectively studied. Echocardiograms were obtained pre-LVAD implantation and then serially at 1, 2, 3, 4, 6, 9, and 12 months post-implantation.
Results The 2 pump types led to similar degrees of mechanical unloading as assessed by invasive hemodynamic status and frequency of aortic valve opening. Myocardial structural and functional parameters showed significant improvement post-LVAD in both AX and CR groups. Left ventricular ejection fraction increased significantly from a mean of 18% to 28% and 26% post-LVAD in the AX and CR groups, respectively. Left ventricular end-systolic volume index and left ventricular end-diastolic volume index decreased significantly as early as 30 days post-implantation in the 2 groups. The degree of myocardial structural or functional response between patients in the AX or CR groups appeared to be comparable.
Conclusions Long-term mechanical unloading induced by AX and CR LVADs, while operating within their routine clinical range, seems to exert comparable effects on myocardial structural and functional parameters.
- axial versus centrifugal
- continuous flow
- left ventricular assist device
- mechanical unloading
- myocardial function
- myocardial structure
Dr. Drakos has received research grant support from Abiomed; and has served as a consultant for HeartWare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 23, 2015.
- Revision received February 16, 2016.
- Accepted February 19, 2016.
- 2016 American College of Cardiology Foundation