Share This Article:

Do Continuous Flow LVADS Improve Diastolic Dysfunction?

Abstract Full-Text HTML Download Download as PDF (Size:1112KB) PP. 23-28
DOI: 10.4236/ojots.2014.43004    2,847 Downloads   3,633 Views   Citations

ABSTRACT

Background: Ventricular assist devices are now used as a bridge to recovery/decision/transplant or as destination therapy in end-stage heart failure. Continued improvements in technology and pump design have made implantation an easier process with reduced operative risks and pump-related adverse events. Considering the beneficial effects of these devices in the clinical setting, it seemed logical to address the long-term effect of the continuous flow pumps on diastolic dysfunction. Methods: This study addresses the effect of HeartMate IITM(HMII) support for 284+/-97 days on echocardiographic parameters of diastolic function. Data from fifteen patients was retrospectively studied status post left ventricular assist device (LVAD) implantation. The data at approximately 1-year post implantation was compared with that obtained prior to implantation. Statistical analyses were performed using the Microsoft Excel Program/MSExcel Stats. Echocardiographic measurements were carried out in accordance with the American Society of Echocardiography guidelines. Results: Of all the echocardiographic parameters assessed only E/Ea and calculated left atrial pressure (LAP) showed a statistically significant decrease. Two parameters that showed a trend towards significance are Ea (septal) and global functional index (p = 0.05). Conclusions: Continuous Flow LVAD support appears to improve diastolic dysfunction. This study has limitations in that we used a single type of continuous flow device (HeartMate IITM) and was conducted as a retrospective analysis. Further studies with larger populations and longer support are required to validate this finding.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Nair, N. , Thotakura, S. and Gongora, E. (2014) Do Continuous Flow LVADS Improve Diastolic Dysfunction?. Open Journal of Organ Transplant Surgery, 4, 23-28. doi: 10.4236/ojots.2014.43004.

References

[1] Rose, E.A., Gelijns, A.C., Moskowitz, A.J., et al. (2001) Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure. New England Journal of Medicine, 345, 1435-1443.
http://dx.doi.org/10.1056/NEJMoa012175
[2] Park, S.J., Tector, A., Piccioni, W., et al. (2005) Left Ventricular Assist Devices as Destination Therapy: A New Look at Survival. Journal of Thoracic and Cardiovascular Surgery, 129, 9-17.
http://dx.doi.org/10.1016/j.jtcvs.2004.04.044
[3] Frazier, O.H., Rose, E.A., Oz, M.C., et al. (2001) Multicenter Clinical Evaluation of the HeartMate Vented Electric Left Ventricular Assist System in Patients Awaiting Heart Transplantation. Journal of Thoracic and Cardiovascular Surgery, 122, 1186-1195.
http://dx.doi.org/10.1067/mtc.2001.118274
[4] Frazier, O.H., RoseE, A., Oz, M.C., et al. (2001) Multicenter Clinical Evaluation of the Heartmate; Vented Electric Left Ventricular Assist System in Patients Awaiting Heart Transplantation. The Journal of Heart and Lung Transplantation, 20, 201-202.
[5] Frazier, O.H., Myers, T.J., Westaby, S. and Gregoric I.D. (2004) Clinical Experience with an Implantable, Intracardiac, Continuous Flow Circulatory Support Device: Physiologic Implications and Their Relationship to Patient Selection. Annals of Thoracic Surgery, 77, 133-142.
http://dx.doi.org/10.1016/S0003-4975(03)01321-3
[6] Miller, L.W., Pagani, F.D., Russell, S.D., et al. (2007) Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation. New England Journal of Medicine, 357, 885-896.
http://dx.doi.org/10.1056/NEJMoa067758
[7] Pagani, F.D., Miller, L.W., Russell, S.D., et al. (2009) Extended Mechanical Circulatory Support with a Continuous-Flow Rotary Left Ventricular Assist Device. Journal of the American College of Cardiology, 54, 312-321.
http://dx.doi.org/10.1016/j.jacc.2009.03.055
[8] Najjar, S.S. (2009) Heart Failure with Preserved Ejection Fraction: Failure to Preserve, Failure of Reserve, and Failure on the Compliance Curve. Journal of the American College of Cardiology, 54, 419-421.
http://dx.doi.org/10.1016/j.jacc.2009.05.011
[9] Mornos, C., Cozm, D., Petrescu, L., Ionac, A., Rusinaru, D. and Dragulescu, S.I. (2010) E/(EaxSa) Estimates Left Ventricular End-Diastolic Pressure in Patients with Severe Mitral Regurgitation. Journal of Heart Valve Disease, 19, 576-583.
[10] Nagueh, S.F., Middleton, K.J., Kopelen, H.A., Zoghbi, W.A. and Quinones, M.A. (1997) Doppler Tissue Imaging: A Noninvasive Technique for Evaluation of Left Ventricular Relaxation and Estimation of Filling Pressures. Journal of the American College of Cardiology, 30, 1527-1533.
[11] Nishimura, R.A., Housmans, P.R., Hatle, L.K. and Tajik, A.J. (1989) Assessment of Diastolic Function of the Heart: Background and Current Applications of Doppler Echocardiography. Part I. Physiologic and Pathophysiologic Features. Mayo Clinic Proceedings, 64, 71-81.
http://dx.doi.org/10.1016/S0025-6196(12)65305-1
[12] Basnight, M.A., Gonzalez, M.S., Kershenovich, S.C. and Appleton, C.P. (1991) Pulmonary Venous Flow Velocity: Relation to Hemodynamics, Mitral Flow Velocity and Left Atrial Volume and Ejection Fraction. Journal of the American Society of Echocardiography, 4, 547-558.
http://dx.doi.org/10.1016/S0894-7317(14)80213-7
[13] Kato T.S., Chokshi, A., Singh, P., et al. (2011) Effects of Continuous-Flow versus Pulsatile-Flow Left Ventricular Assist Devices on Myocardial Unloading and Remodeling. Circulation: Heart Failure, 4, 546-553.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.962142
[14] Bartoli, C.R., Giridharan, G.A., Litwak, K.N., Sobieski, M., Prabhu, S.D., Slaughter, M.S. and, Koenig, S.C. (2010) Hemodynamic Responses to Continuous versus Pulsatile Mechanical Unloading of the Failing Left Ventricle. ASAIO Journal, 56, 410-416.
http://dx.doi.org/10.1097/MAT.0b013e3181e7bf3c
[15] Wever-Pinzon, O., Stehlik, J., Kfoury, A.G., et al. (2012) Effects of Continuous-Flow Left Ventricular Assist Device Unloading on the Diastolic Function of the Failing Human Heart.[Abstract 19188] American Heart Association Scientific Sessions, Los Angeles.
http://circ.ahajournals.org/cgi/content/meeting_abstract/126/21_MeetingAbstracts/A19188
[16] Drakos, S.G., Wever-Prinzon, O., Selzman, C.H., et al. (2013). Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights Into Cardiac Recovery. Journal of the American College of Cardiology, 61, 1985-1994.
http://dx.doi.org/10.1016/j.jacc.2013.01.072

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.