A UK Single Centre Retrospective Analysis of the Relationship between Haemodynamic Changes and Outcome in Patients Undergoing Prolonged Left Ventricular Assist Device Support

Abstract

IntroductionAlthough heart transplantation remains the gold standard for the treatment of end-stage heart failure with an average 2-year survival rate of 80%, 1) its epidemiological impact is limited by organ availability. 2) Over the last 5 years, rotary left ventricular assist devices (LVADs) have been used increasingly either as a bridge to transplant or for permanent support. In spite of their clinical efficacy, LVADs remain associated with serious complications which compromise outcome. However, the association between changes in haemodynamic parameters during support and outcome remains inadequately Purpose: Despite their efficacy, LVADs remain associated with serious complications. The relationship between haemodynamic changes during support and outcome remains inadequately characterised. This association was investigated in LVAD recipients undergoing prolonged support. Methods: Forty patients receiving LVAD therapy for >2 years were reviewed retrospectively (mean support duration was 38.62 ± 15.28). Pre-and on-LVAD haemodynamic data were assessed in three groups: (1) those receiving ongoing support (n = 24); (2) those who underwent cardiac transplantation (n = 4); (3) those who died during support (n = 12). Results: For group 1 and 2, LVAD support achieved a decrease in mean PAP, mean PCWP, TPG, and PVR and an increase in thermodilution blood flow (TBF) with significance at ≤5% level. For group 3, there were non-significant changes in TPG and PVR at the 5% level but for mean PAP, mean PCWP, and TBF the changes were similar to Groups 1 and 2 with significance at ≤5% level. Aggregated data from all three groups showed a 58% increase in TBF on LVAD support. Conclusion: Highly significant and favourable haemodynamic changes were found. However, group 3 did not undergo decrease in TPG and PVR possibly because of suboptimal LVAD flow, right heart dysfunction and unavoidable prolongation of support.

Simulation as a preoperative planning approach in advanced heart failure patients. A retrospective clinical analysis

“…The simulation outcome for patient 1 does show a leftward shift of the pressure–volume loops for the left and right ventricles with adequate ventricular volumes, although the gain in ejection fraction may be initially limited. On the contrary, it is true that further improvement is observed over a period of time [ 84 ] making LVAD insertion a suitable option for this patient. Because of the potential complications related to the associated co-morbidities, the unanimous clinical decision to decline any further intervention but continue with medical treatment and eventually palliation may have been the way forward although further argument in favour of LVAD insertion would be the recent evidence supporting the “obesity paradox” in cardiac surgery [ 85 ], which is currently the subject of a hot debate.…”

New Treatment for Percutaneous Sites in Patients with a Ventricular Assist Device: Nihon University Crystal Violet Method

“…[1][2][3][4] Cerebrovascular disorders and percutaneous site (cannula site and driveline) infections are the most frequent complications after VAD implantation. It has been reported that VAD-related infections occur in 9.8%-51.9% of patients at an average of 68 days to 9.2 months after implantation and can have a major influence on survival.…”