Differences in Pulsatile and Non-pulsatile Mechanical Circulatory Support in Long-Term Use Thorsten Drews, MD, Michael Jurmann, MD, † Dandel Michael, MD, PhD, Pasic Miralem, MD, PhD, Yuguo Weng, MD, PhD, and Roland Hetzer, MD, PhD Background: Non-pulsatile left ventricular assist device (LVADs) systems have attained more interest for long-term use. We present the results of mechanical circulatory support (MCS) with pulsatile and non-pulsatile LVAD in use in patients for more than 1 year. Methods: Between February 1999 and February 2006, 48 patients (mean age, 51; range, 20 –72 years) received an LVAD: 24 each had pulsatile (Group A) and non-pulsatile MCS (Group B). Results: Mean support time was 862 days (range, 366 –1876 days) in Group A, and 631 days (range 368 –1129 days) in Group B. In Group A, 20 patients (80%) were at home for more than 1 year, in Group B, 21 patients (88%). Five VAD-related complications occurred (4 pump exchanges, 1 controller exchange). Echocardiography showed better LV unloading, and the LV end-diastolic diameter was significantly lower in Group A (60 mm) than in Group B (69 mm). Neither the number of driveline/cannula infections nor the number of bleeding and embolic complications differed significantly between groups. Thirty-two patients received heart transplants, 11 died, and 5 still have the VAD. Conclusions: Although echocardiographic data show that pulsatile LVADs seem to better unload the LV, this could not be confirmed by data from right ventricle catheterization. Owing to sufficient LV unloading, longer device durability, less need of anticoagulation therapy, and greater quality of life, non-pulsatile devices are preferred for long-term use. Nevertheless, both systems can be used with good quality of life and an acceptable rate of complications for extended periods of time. J Heart Lung Transplant 2008;27: 1096-101. Copyright © 2008 by the International Society for Heart and Lung Transplantation. Before the first heart transplantation was performed in 1967, 1 the first mechanical circulatory support (MCS) device had been implanted by DeBakey in 1963. 2 In 1969 Cooley implanted a totally artificial heart in a 54-year-old man as a bridge to heart transplantation. 3 In the years that followed, multiple pulsatile systems physiologically com- parable to the beating heart 4 were developed. With the voluminous first generation of implanted devices, pocket bleeding and infection were common complications. Af- ter the introduction of the second-generation devices, which are smaller and have non-pulsatile flow (DeBakey LVAD in November 1998, the Jarvik 2000 Heart in April 2000), these complications have been minimized. 5,6 The longer-term use of MCS has always been compli- cated by the risk of thromboembolism. 7–9 With the development of the third generation of MCS systems, with magnetic bearings (Berlin Heart INCOR [Berlin Heart GmbH, Berlin, Germany] first implanted in June 2002, and DuraHeart [Terumo Heart Inc., Ann Arbor, MI] in January 2004), further progress has been made in minimizing these problems. 10 Up until now, 1,282 MCS systems have been implanted at our institution. Of these, 932 were pulsatile systems, consisting of the Berlin Heart EXCOR (Berlin Heart GmbH, Berlin, Ger- many), Novacor (Baxter Healthcare Corp, Berkeley, CA), Heart Mate I and II (Thermo Cardiosystems Inc, Woburn, MA), Abiomed (Abiomed Inc, Danvers, MA), LionHeart (Arrow International Inc, Reading, PA), Car- dioWest (SynCardia, Tucson, AZ), and Total Artificial Heart (Buecherl Heart, Berlin, Germany). Also implanted were 350 non-pulsatile devices, including the DeBakey LVAD (Micromed Technology Inc, Houston, TX), Berlin Heart INCOR, DuraHeart, and CorAide (Arrow Interna- tional Inc, Reading, PA). Now, with these developments, the question arises whether pulsatile (first generation) and non-pulsatile systems (third generation) can ensure the same good quality of life and a similarly low rate of complications for extended periods of time. We investigated whether the flow and the LV unloading achieved with non- From the Department of Cardiothoracic and Vascular Surgery, Deut- sches Herzzentrum, Berlin, Germany. Submitted January 24, 2008; revised May 19, 2008; accepted July 1, 2008. †This article is dedicated to the memory of the late Dr Michael Jurmann, a colleague at the Deutsches Herzzentrum Berlin and coauthor of this work. Reprint requests: Dr. Thorsten Drews, Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augusten- burger Platz 1, 13353 Berlin, Germany. Telephone: +49-30-4593- 2076. Fax: +49-30-9168-9748. E-mail: drews@dhzb.de Copyright © 2008 by the International Society for Heart and Lung Transplantation. 1053-2498/08/$–see front matter. doi:10.1016/ j.healun.2008.07.007 1096 MECHANICAL CIRCULATORY SUPPORT