The Effect of Artificial Pulsatility on the Peripheral Vasculature in Patients With Continuous-Flow Ventricular Assist Devices

Implantation of left-ventricular assist systems (LVASs) has become the standard of care for advanced heart failure (HF). The absence of pulsatility in previous devices contributes to vascular and endothelial dysfunction related to atherosclerotic or vascular complications. We hypothesized that the artificial pulsatility provided by the HeartMate 3 (HM3) (Abbott, Chicago, IL) LVAS would exert a favourable effect on the vasculature. In 32 patients implanted with HM3 (5 female patients, mean age 55 ± 13.6 years), the reactive hyperemia index (RHI) and peripheral augmentation index (AI), markers of endothelial function and arterial stiffness, were measured with an EndoPAT2000 before and in the third and sixth month after implantation. RHI and AI data from 30 HeartMate II (HM II) (Abbott) recipients in the third and sixth month after implantation, from 15 patients with advanced HF without LVASs and from 13 healthy volunteers were also analyzed. In HM3 recipients, the mean RHI significantly decreased at 3 and 6 months after implantation. The RHI was substantially lower at baseline than that of healthy or the HF reference group. Increasing AI values, indicating worsening arterial stiffness, were also observed. Similar trends were observed in HM II recipients between the third and sixth months but with higher absolute values of RHI and AI. We detected impaired vascular function in HM3 patients and provided additional evidence on the negative effect of low pulsatility on vascular function after LVAS implantation. The results suggest that the artificial pulsatility of the HM3 does not avert the progression of endothelial dysfunction. L'implantation de dispositifs d'assistance ventriculaire gauche (DAVG) est devenue un standard des soins pour une insuffisance cardiaque (IC) avancée. L'absence de pulsatilité dans les dispositifs précédents contribue à la dysfonction vasculaire et endothéliale liée aux complications athérosclérotiques ou vasculaires. Nous avons émis l'hypothèse que la pulsatilité artificielle fournie par le DAVG HeartMate 3 (HM3) (Abbott, Chicago, IL) entraînerait un effet bénéfique sur le système vasculaire. Chez 32 patients implantés avec le HM3 (5 femmes, âge moyen 55 ± 13,6 ans), l'indice d'hyperémie réactive (IHR) et l'indice d'amplification périphérique (IAP), marqueurs de la fonction endothéliale et de la rigidité artérielle, ont été mesurés par un EndoPAT2000 avant puis trois et six mois après implantation. Les données IHR et IAP de 30 patients