Methods

1. Differences in Pulsatile vs. Continuous-Flow Left Ventricular Assist Devices on Renal FunctionAntone Tatooles, MD; Laura A. Coyle, MSN, ACNP-BC; Colleen T. Gallagher, RN, BSN; Geetha Bhat, PhD, MD, FACC; Pat Pappas, MD Advocate Christ Medical Center, Oak Lawn, Illinois Background Methods Results Results Despite improved survival and quality of life long term use with a first generation pulsatile left ventricular assist devices (LVAD) was limited due to large pump size and mechanical durability. Advanced technology led to the development of continuous-flow LVADs which are smaller, quieter with greater mechanical durability providing a longer duration of support and continue to gain interest for destination therapy or permanent use. Patients supported with a LVAD have demonstrated improved hemodynamic support and preserved end organ function. Concern has been raised that pulsatile and continuous-flow LVADs will not provide the same quality of circulatory support. 22 men and 1 female (4%) average age 58 yrs (range 29-81) with a pulsatile LVAD achieved a significant p < .05 improvement in renal function 30 days after LVAD implant which was maintained at 90, 180 and 365 days. 17 men and 6 female (26%) average age 60 yrs (range 28-78) with a continuous-flow LVAD achieved a significant p < .05 improvement in renal function 30 days after LVAD implant and maintained improved function out to 1 year. Pulsatile Cr MDRD GFR Baseline 1.76 50.74 30 Days 1.34 72.48 90 Days 1.27 69.26 180 Days 1.43 63.09 365 Days 1.58 60.87 Continuous-Flow Cr MDRD GFR Baseline 1.60 56.26 30 Days 1.32 66.87 90 Days 1.36 62.35 180 Days 1.42 59.39 365 Days 1.46 58.66 Conclusions Objectives Patients with either a pulsatile or continuous-flow LVAD have improved renal function one year after implantation. Patients treated with a pulsatile device are able to maintain a significantly improved renal function at 30, 90, 180, and 365 days. Treatment with a LVAD improves end organ function contributing to an improved quality of life. MDRD derived GFR The aim of this study was to evaluate the difference between pulsatile and continuous-flow LVADs on renal function in a destination therapy (DT) population. Methods All patients (n = 46) who were supported > 1 year with either a pulsatile (n = 23) or continuous-flow LVAD (n = 23) for DT between March 2005 and December of 2008 at Advocate Christ Medical Center were retrospectively analyzed. Renal function was assessed by two calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease (MDRD) derived GFR (ml/min/1.73 m2) and the Cockcroft-Gault derived creatinine clearance (CrCl, ml/min) at baseline, 30, 90, 180 and 365 days. Days on LVAD Statistical significance was not achieved at 90, 180, 365 days in patients treated with a continuous-flow LVAD. Similar findings were demonstrated with the Cockcroft-Gault calculated CrCl for all patients. References • Slaughter MS, Rogers JG, Milnao CA, Russell SD, Conte JV, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009; 361