The Effect of Artificial Pulsatility on the Peripheral Vasculature in Patients with A Continuous-Flow Ventricular Assist Device

Abstract Background 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) LVAS would exert a favorable effect on the vasculature. Methods In 32 patients implanted with HM3 (5 females; 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 Endo-PAT2000 prior to and in the 3rd and 6th months after implantation. RHI and AI data from 30 HeartMate II (HM II) recipients in the 3rd and 6th months after implantation, from 15 advanced HF patients without LVASs, and from 13 healthy volunteers were also analyzed. Results In HM3 recipients, the mean RHI significantly decreased at 3rd and 6th months after implantation. The RHI was substantially lower at baseline than that of healthy or HF reference group. Increasing AI values, indicating worsening arterial stiffness, were also observed. Similar trends were observed in HM II recipients between the 3rd and 6th months, but with higher absolute values of RHI and AI. Conclusions 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.