Advertisement

Normalization of Hemodynamics Following LVAD Implantation May be Related to Improved Long Term Outcome

      Purpose

      Continuous flow left ventricular assist devices (CF-LVAD) improve hemodynamics in heart failure patients. However, data is lacking to demonstrate a significant correlation between post-implantation hemodynamic improvement and changes in outcomes. This study aims to assess the relationship between improvements in hemodynamic measures and post CF-LVAD survival.

      Methods

      A retrospective chart review was conducted for all CF-LVAD patients in a large center between 2009-2013. Patients who had undergone a right heart catheterization (RHC) before implantation and within 3-6 months post-implantation were included. Data was collected from the electronic medical record. Primary outcome was improvement in hemodynamics normalization. Normal Hemodynamics were defined as the following: right atrial pressure < 12 mmHg, pulmonary capillary wedge pressure < 18 mmHg, and cardiac index (by Fick method) > 2.1. Secondary outcome was Kaplan-Meier survival analysis. Patients were stratified into two groups based on the number of hemodynamics criteria that were normalized post-implantation: completely normalized or partially normalized.

      Results

      54 patients had hemodynamic data collected within the study period and were included. The number of abnormal hemodynamics parameters decreased in 45 patients after CF-LVAD implantation. Only 46% of the patients had complete normalization of hemodynamics while 28% of the patients improved most of their hemodynamics (only 1 parameter was not normalized) and 36% of the patients remained with multiple abnormal hemodynamics (2 or more) despite CF-LVAD support. The group with complete resolution trended to better 2 years survival (p=0.17) (figure 1).

      Conclusion

      CF-LVAD implantation led to a complete resolution of cardiogenic shock parameters in only 46% of patients. Patients with complete resolution of cardiogenic criteria trend to better outcome, however larger studies will be required to learn the role hemodynamic optimization plays in the outcomes of CF-LVAD patients.
      Figure thumbnail fx1
      Figure 1Kaplan-meier survival curves of patients with complete normalization of cardiogentic shock parameters compared to those complete normalization.