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


      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.


      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.


      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).


      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.
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      Figure 1Kaplan-meier survival curves of patients with complete normalization of cardiogentic shock parameters compared to those complete normalization.