Background: Continuous flow left ventricular assist devices (LVADs) are the standard of care for end-stage heart failure. There are different flow characteristics in 2nd (axial) versus 3rd (centrifugal) generation continuous flow LVADs. We compared post implant hemodynamics in 2nd and 3rd generation LVADs.
Methods: We performed a retrospective analysis of patients implanted with 2nd and 3rd generation isolated LVADs from 2008 to 2012. Fifty patients, with a minimum of 6 month support were included. Of those, 39 patients (78%) had 2nd generation LVADs (Group A), and 11 patients (22%) had 3rd generation LVADs (Group B). Baseline characteristics and hemodynamics were comparable between groups.
Results: Average support time was 20.5±8.9 and 24.1±8.2 months for Group A and Group B, respectively (NS). Central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), pulmonary vascular resistance (PVR) and trans-pulmonary gradient (TPG) pre-implant and at 6, 12 and 18 months are shown in Table 1. There was a significant difference in CVP and PCWP in 2nd vs 3rd generation LVAD at 18 months.
Conclusions: There appears to be a more sustained ventricular unloading in the 2nd vs 3rd generation LVADs. Several factors may contribute to this discrepancy including patient selection, clinical management, unique flow characteristics and mechanisms of ventricular unloading for 2nd vs 3rd generation LVADs. These findings should be further investigated.
