Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring

Abstract

AimsThe time course of changes in pulmonary artery (PA) pressure due to left ventricular assist devices (LVADs) is not well understood. Here, we describe longitudinal haemodynamic trends during the peri‐LVAD implantation period in patients previously implanted with a remote monitoring PA pressure sensor.Methods and resultsWe retrospectively studied PA pressure trends in patients implanted with CardioMEMS™ PA pressure sensor between October 2007 and March 2017 who subsequently had an LVAD procedure. Data are presented as mean ± standard deviation, and P‐values are calculated using standard t‐test with equal variance. Among 436 patients in cohort, 108 (age 58 ± 11 years, 82% male) received an LVAD and 328 (age 60 ± 13 years, 70% male) did not. The mean PA pressure at sensor implant was higher by 29% (P < 0.001) among patients who later received LVAD. Mean PA pressure 6 months prior to LVAD implant was 35.5 ± 8.5 mmHg, increasing to 39.4 ± 9.9 mmHg (P = 0.04) at 4 weeks before LVAD, and then decreasing 27% to 28.8 ± 8.4 mmHg (P < 0.001) at 3 months post‐implant and stabilizing at 31.0 ± 9.4 mmHg at 1 year.ConclusionsPatients who later receive LVADs have higher PA pressures at sensor implant and show a further increase leading up to LVAD implantation. There is a significant reduction of PA pressures post‐LVAD implantation that persists long term. PA pressure monitoring may aid in the clinical decision making of timing for LVAD implantation and in management of LVAD patients.

Physiology of the Assisted Circulation in Cardiogenic Shock: A State-of-the-Art Perspective

“…Remote hemodynamic monitoring using intrapulmonary pressure sensors is another promising approach for the management of LVAD patients, during the early postoperative course and later for decision to bridge the patient to HTx, based on the level of pulmonary hypertension (Figure 5). 74,75…”

Management of the Patient with Heart Failure and an Implantable Pulmonary Artery Hemodynamic Sensor

“…The use of hemodynamic monitoring in other patient populations not included in CHAMPION is being actively explored. Ambulatory hemodynamic monitoring may facilitate early identification of stage D HF patients who should be referred for LVAD or heart transplantation [44]. After LVAD implantation, some patients continue to have significant functional limitations and/or abnormal hemodynamic profiles that can be improved with more intensive medical treatment or changes in device speed [45].…”

A current and future outlook on upcoming technologies in remote monitoring of patients with heart failure

“…There are few published data on RM with CardioMEMS™ for patients with left ventricular assist devices (LVAD). In a retrospective analysis of 436 patients who had received a CardioMEMS™ device, 108 of whom also received an LVAD, 42 the mean PA pressure at the time of CardioMEMS™ implantation was higher ( P < 0.001) in the group that subsequently received an LVAD. Mean PA pressures decreased after LVAD implantation and remained stable for 1 year.…”