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J Thorac Cardiovasc Surg 2008;136:524-525
© 2008 The American Association for Thoracic Surgery

Brief Communication

Longer duration of continuous-flow ventricular assist device support predicts greater hemodynamic compromise after return of pulsatility

College of Physicians and Surgeons, Columbia, University, New York, NY

Received for publication August 10, 2007; revisions received November 9, 2007; accepted for publication December 27, 2007.

^_* Address for reprints: Mark J. Russo, MD, MS, Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, Milstein Hospital Bldg, Room 7-435, New York, NY 10032. (Email: mr2143@columbia.edu).

The first 20% of the full text of this article appears below.

Continuous-flow ventricular assist devices (CVADs) are more compact, less costly, and potentially more durable than pulsatile ventricular assist devices (PVADs). However, studies in animal models suggest that long-term continuous-flow support can result in hemodynamic dysfunction. This includes the disruption of the renin-angiotensin system¹ and the response to norepinephrine administration in comparison with PVADs.² The purpose of this study was to determine whether CVAD insertion and duration of CVAD support was associated with greater hemodynamic compromise after return to pulsatility after device explantation and heart transplantation.

Clinical Summary

We retrospectively reviewed 44 consecutive patients undergoing heart transplantation/ventricular assist device (VAD) explantation at our institution. These included 33 PVADs and 11 CVADs. All patients in the study had New York Heart Association stage IV congestive heart failure at the time of LVAD insertion and were successfully bridged to transplantation with no mortality on the device. Doses of all continuously infused pressors administered to patients for 7 postoperative days were collected. The degree of pressors and inotropic support was assessed by using a composite pressor/inotropic score ( Table 1) . . . [Full Text of this Article]

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