Pagani, F. D. et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J. Am. Coll. Cardiol. 54, 312–321 (2009).

Their findings suggest that this new technology provides effective hemodynamic support...

Left ventricular assist devices (LVADs) are often used in patients requiring heart transplantation, either as a nonpermanent management option until a donor heart becomes available, or as a permanent alternative to transplantation. Historically, LVADs have been designed to cyclically fill and empty; however, these pulsatile devices required a large pump, and recipients are likely to need reoperation for device exchange as a result of infection or malfunction. A prospective, multicenter study of the continuous-flow rotary pump HeartMate II® LVAD (Thoratec Corporation, Pleasanton, CA)—which has a smaller pump than the older, pulsatile devices—began enrolment in 2005. Francis Pagani and colleagues have now reported on the first 281 patients who completed the study end points or attended a follow-up assessment 18 months after implantation. Their findings indicate that this new technology provides effective hemodynamic support over this time period.

Of the 281 patients included in this analysis, 157 had received a heart transplant, 58 were still on HeartMate II® LVAD support, and 7 had recovered cardiac function and had their LVAD removed. In total, 56 of the patients died and 7 of the deaths were classified as device-related; 4 were caused by malfunction of internal components and 3 by malfunction of external components. No failures in the mechanical pumping mechanism were reported for this patient population. At the time of the assessment, 9 devices had been replaced with another HeartMate II® LVAD and 3 devices had been exchanged for another type of LVAD. For those who had continued on the HeartMate II® LVAD support, overall survival was 82% at 6 months, 73% at 1 year and 72% at 18 months. Substantial improvements in patient function and quality of life were observed after 6 months of LVAD support.

Pagani believes that “the most significant finding [of this study] is the durability and reliability of the device” and, based on comparisons with results from other studies, the authors conclude that the continuous-flow rotary pumps are better than their pulsatile counterparts.