Abstract 3661: Equal Success, but Shorter Length of Stay, With Axial Versus Pulsatile Flow Left Ventricular Assist Devices (LVAD) as Bridge to Cardiac Transplantation (BTT): The Columbia Presbyterian Experience
Introduction: The Heartmate II (HM II), an axial flow LVAD, was recently approved for BTT therapy. Nationwide registries have indicated superior outcomes to historical data obtained with the pulsatile flow Heartmate I (HM I). We reviewed our experience with both LVADs with attention to length of stay (LOS).
Methods: Retrospective chart review of all patients who received HM I (n=75) or HM II (n=24) as BTT between 2/2004 and 6/2008 were reviewed. Success was defined as being listed for heart transplantation on day 180 post implant or having undergone transplantation prior to day 180.
Results: Overall pre-implant, post-implant, and total LOS for HM I remained stable throughout the 4 year period and averaged 12.2, 45.7, and 57.8 days, respectively. There were no differences in age (51 vs 53 yrs), bypass time (111 +64 vs. 90 +58 min, p NS) or preoperative LOS (12.2 vs 13.1 days) between subjects receiving HM I and HM II. Success was observed in 85% of HM I recipients and 88% of HM II recipients (p NS). However, postoperative LOS was 45 days for HM I recipients versus 29 days (p<0.05) for HM II recipients resulting in an overall LOS reduction of 16 days.
Conclusions: While comparable excellent success rates can be achieved with HM I and HM II as BTT in a high volume center, recovery is faster and LOS is shorter after HM II implantation for BTT; likely due to the less traumatic insertion of a smaller pump. Aside from economical considerations, these differences may have outcome implications in the older destination therapy population.