Long-term mechanical circulatory support: Differences with pulsatile and non-pulsatile systems

Aims: With increased use of ventricular assist devices (VADs), non-pulsatile systems have attained more interest for long-term use. We present the results of mechanical circulatory support (MCS) with pulsatile and non-pulsatile LVADs employed in patients for over 1 year. Methods: Of 48 patients, 24 were on pulsatile (13 Novacor, 9 Berlin-Heart Excor, 2 Lion Heart) and 24 on non-pulsatile MCS (22 Berlin-Heart Incor, 2 DuraHeart), implanted between 02/1999 and 02/2006at a mean age of 51 (20–72) years. Results: In the pulsatile group mean support time was 862 (range 366–1876) days, in the non-pulsatile group 631 (range 368–1129) days. In the first group 20 patients (80%) were at home for >1 year, in the second group 21 patients (88%). There were 5 assist-device-related complications with 4 cases of pump exchange (3 Novacor, 1 Incor) and 1 of controller exchange (Lion Heart). Echocardiography showed better LV unloading with significantly lower LV enddiastolic diameter in the pulsatile group (60mm) than in the non-pulsatile group (69mm). Neither the number of driveline/cannula infections nor the number of bleeding and embolic complications differed significantly between the two groups. Thirty-two patients received heart transplants, 11 died, and five are still on the device. Conclusions: No significant differences in complication rates were seen; nevertheless, the better left ventricular unloading with pulsatile devices seems to make them more appropriate for long-term use. Both pulsatile and non-pulsatile systems can be used for extended periods with good quality of life and an acceptable complication rate.