Liver Dysfunction after a Left Ventricular Assist Device: A Comparison between Pulsatile and Non-Pulsatile Pumps

Background: The relationship between the heart and the liver is well established. Hyperbilirubinemia, a common complication associated with left ventricular assist device (LVAD) implantation, appears as a result of liver dysfunction and can turn into a life-threatening problem. Previous studies have related these events to intrahepatic cholestasis and centrilobular liver necrosis. In this study we want to observe if there is any difference between the type of pump used and the presence of liver dysfunction. Method: We retrospectively compared and analyzed 40 non-pulsatile LVAD (Jarvik 2000) and 48 pulsatile LVAD (HeartMate II). These LVADs were implanted between June 1999 and December 2006. Results: Baseline clinical characteristics were similar in the two groups. Hemodynamic parameters were similar in both groups after the implantation of the LVAD. Patients with non-pulsatile pumps had a slightly bigger number of days with the pump (171 days vs. 165 days – p > 0.05). There was an almost 10% increase in the first month mortality in the non-pulsatile LVAD patients (p < 0.05) when compared to pulsatile pumps. There was also a higher incidence of positive blood culture in non-pulsatile pumps being Staphylococcus aureus the most prevalent pathogen. Patients with Jarvik 2000 reached in average higher values in the liver function tests with a peak value at week two after the implantation. HeartMate II patients had lower values and a peak value around week 1. 10% of the patients had a liver biopsy which showed intrahepatic cholestasis except in one patient which showed a biliary hamartoma. Conclusion: The data shows clearly that there is a relation between the type of pump used and the presence of liver dysfunction, morbidity and mortality. A higher incidence of liver dysfunction could be associated with the bigger amount of positive blood cultures and with the fact that non-pulsatile pumps give a non-physiologic waveform.Tabled 1Direct Billirubin in LVAD patientsInitialDay 2Day 4Week 1Week 2Month 1J 20000.862.554.15.89.294.9HeatMate II0.792.273.95.45.22.44p < 0.05. Open table in a new tab Tabled 1LDH in LVAD patientsInitialDay 2Day 4Week 1Week 2Month 1J 2000342.08450.46527.97652.24902.21621.97HeartMate II302.67430.19440.11575.84408.41379.65 Open table in a new tab Tabled 1LDH in LVAD patientsInitialDay 2Day 4Week 1Week 2Month 1J 2000342.08450.46527.97652.24902.21621.97HeartMate II302.67430.19440.11575.84408.41379.65p < 0.05. Open table in a new tab p < 0.05. p < 0.05.