Right Ventricular Function in Patients With Left Ventricular Assist Device Support by Pulsatile Polvad MEV and Continuous-Flow Pumps Heartware and Heartmate II

• The right ventricle plays a main role in left ventricular assist device (LVAD) support.
• Some degree of right heart dysfunction is always present in patients with end-stage heart failure.
• Implementation of an LVAD changes the conditions for the right ventricle and requires increase of flow.
• For the 1st time, the pulsatile Polvad MEV LVAD was compared with newer continuous-flow devices Heartware and Heartmate II.

BackgroundLeft ventricular assist device (LVAD) support is increasingly used in patients with heart failure. The right ventricle (RV) plays a main role in LVAD support. Little is known about the effects of pulsatile Polvad MEV devices or continuouseconds flow pumps on RV function. We compared hemodynamic parameters of RV in patients after implantation of Polvad MEV (PM) and Heartware (HW) or Heartmate II (HMII) LVADs.MethodsForty-four patients were retrospectively reviewed after implantation of PM (group P; n = 24 [21 M, 3 F]) or HW or HMII (group C; n = 20 [20 M, 0 F]) LVADs from April 2007 to February 2014. Hemodynamic data—mean pulmonary pressure (mPAP), central venous pressure (CVP), cardiac output (CO), and cardiac index (CI)—were collected before surgery, after surgery, and every 2 hours in the intensive care unit, with the time points numbered from 1 to 120. Right ventricular work (RVW) was calculated according to the equation: RCW = CO × (mPAP − CVP) × 0.0144 (g·m).ResultsBaseline characteristic of the patients were similar. mPAP values were similar between groups. CVP values were higher in group P, significantly at time points 5 and 7–33. CO values were higher in group C, significantly from point 3 and almost all the time to point 43. CI reached significance at point 9, 12–14, 16–19, and 30–41. RCW was higher in group P before implantation. Post-implantation RCW values were higher in group C, significantly at time points 19, 20, 32–34, 51–53, and 55–57.ConclusionsContinuous-flow pumps more effectively optimize RV function than pulsatile LVADs, which can result in more effective prevention of RV failure or insuffiency in that group.