Comparison of heart transplant outcomes between recipients with pulsatile- vs continuous-flow LVAD

J Card Surg. 2019 Oct;34(10):1062-1068. doi: 10.1111/jocs.14210. Epub 2019 Aug 7.


Objective: Continuous-flow (CF) left ventricular assist devices (LVADs) have replaced pulsatile flow (PF) LVADs irrespective of concerns from the physiologic changes/morbidity secondary to lack of pulsatility. Data comparing posttransplant outcomes in patients with CF vs PF LVADs are limited and conflicting. We used the Organ Procurement and Transplant Network database to compare posttransplant outcomes between CF and PF LVAD patients.

Methods: From 1 January 2005 to 31 December 2011, 3449 adult patients underwent primary heart alone transplantation. The cohort was restricted to 2741 recipients with LVAD at the time of transplant and divided into two groups: PF (Heartmate XVE) (n = 705) and CF (Heartmate II, HeartWare HVAD, and Jarvik 2000) (n = 2036). Endpoints were 30-day freedom from graft failure, 1-, and 5-year patient survival. Propensity score matching identified 705 pairs for adjusted comparisons.

Results: Among propensity-matched patients, 30-day freedom from graft failure after heart transplantation (PF = 94.8% vs CF = 95.2%, P > .7), and 1-, and 5-year patient survival (PF; 87.5% vs CF; 88.9%, P = .4, and PF;75.7% vs CF;77.5%, P = .3) were not different.

Conclusion: Survival and freedom from graft failure after heart transplantation is similar between CF and PF LVADs. These findings are relevant as the use of CF devices increases despite physiologic changes related to the absence of pulsatility.

Keywords: assist device; cardiovascular research; transplant.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / surgery*
  • Heart Transplantation*
  • Heart-Assist Devices*
  • Humans
  • Male
  • Middle Aged
  • Propensity Score*
  • Prosthesis Design
  • Pulsatile Flow / physiology*
  • Retrospective Studies
  • Survival Rate / trends
  • Time Factors
  • Tissue and Organ Procurement
  • Transplant Recipients*
  • Treatment Outcome
  • United States / epidemiology