Comparison of Cardiac Reverse Remodeling between Older and Newer Generation Continuous-Flow LVAD
Yin M, Michaels A, Genovese L, Indaram M, Shah K, Singh R, Caine W, Nemeh H, Alharethi R, Tang D, Selzman C, Kanwar M, Cowger J, Shah P, and Drakos SG. Comparison of Cardiac Reverse Remodeling between Older and Newer Generation Continuous-Flow LVAD. J Heart Lung Transplant 2021; 40(4):S82.
J Heart Lung Transplant
Purpose: The purpose of our study is to compare the left ventricular (LV) functional and structural changes following mechanical circulatory support (MCS) between continuous-flow left ventricular assist devices (CF-LVADs) that provide mechanical unloading characterized by specific bioengineering differences.
Methods: The study enrolled 311 chronic HF patients undergoing MCS with HVAD (HW, hybrid levitation centrifugal pump, n=95), HeartMate 3 (HM3, full magnetic levitation centrifugal pump, n=140), and HeartMate II (HM2, axial flow pump, n=76) at four sites across the US. Echocardiographic parameters of LV structure and function were obtained pre-implant and at 1, 3, 6, and 12 months of CF-LVAD support.
Results: There were no significant differences in baseline characteristics between groups. At 3 months post-LVAD support the LV ejection fraction (LVEF) was higher (p=0.03, Figure 1A) and left ventricular end diastolic diameter (LVEDD) was lower (p=0.04, Figure 1B) in HMII patients, but there were no significant difference in LVEF and LVEDD between devices at 6 or 12 months. The proportion of patients achieving “cardiac reverse remodeling responder” status (defined as improvement of LVEF to ≥40% and LVEDD <6.0cm) was 9.32%, and comparable between the CF-LVADs.
Conclusion: The newest generation full magnetically levitated CF-LVAD results in similar cardiac reverse remodeling as older generation CF-LVADs. These findings suggest that the fully magnetically levitated device technology could provide an adequate platform to further study and promote reverse cardiac remodeling clinically.