Clinical hemodynamic evaluation of patients implanted with a fully magnetically levitated left ventricular assist device (HeartMate 3)

Uriel, Nir; Adatya, Sirtaz; Malý, Jiří; Kruse, Eric; Rodgers, D.; Heatley, Gerald J.; Herman, A.; Sood, Poornima; Berliner, Dominik; Bauersachs, Johann; Haverich, Axel; Želı́zko, Michael; Schmitto, Jan D.; Netuka, Ivan

doi:10.1016/j.healun.2016.07.008

Cited by 60 publications

(45 citation statements)

References 14 publications

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“…An important finding from this study is that clinical stability does not necessarily mean optimal LVAD speed and adequate unloading. This is consistent with previous studies by Uriel et al, where only 63% of HM3 patients had optimal haemodynamics (compared with 43% of our patients who were adequately unloaded) at baseline LVAD speed of 5307 ± 149 rpm, which was considerably higher than our pre‐RAMP speed …”

Section: Discussionsupporting

confidence: 93%

Validation of non‐invasive ramp testing for HeartMate 3

et al. 2020

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Aims Ramp testing in the postoperative period can be used to optimize left ventricular assist device (LVAD) speed for optimal left ventricular (LV) unloading. We tested the hypothesis that a non-invasive echocardiographic ramp test post-HeartMate 3 implantation improves LV unloading immediately after and 1-3 months after as compared with before the test. We also tested a secondary hypothesis that speed adjustments during echocardiography-guided ramp testing do not worsen right ventricular (RV) function immediately after and 1-3 months after. Methods and resultsWe retrospectively reviewed data from patients who underwent an echocardiographic ramp test. A total of 14 out of 19 patients were clinically stable and were enrolled. Adequate LV unloading was defined as no more than mild mitral regurgitation, and intermittent aortic valve (AV) opening or closed AV, and reduction of left ventricular end-diastolic diameter (LVEDD); and for the follow-up measurement, decreased NT-proBNP. Median (interquartile range) time from implantation to ramp test was 27 (16; 56) days, and median time from ramp test to follow-up echocardiography was 55 (47; 102) days. Median LVAD speed achieved during ramp testing was 5550 (5375; 6025) revolutions per minute (rpm), and median final LVAD speed was 5200 (5000; 5425) rpm. Ramp testing resulted in final LVAD speed increase in 11 (79%) patients and a median net change of 200 (200; 300) rpm. Speed adjustments after ramp testing resulted in improved LVAD unloading that was achieved in additional 3 (21%) patients who were not originally optimized. RV function did not worsen significantly during ramp testing or at final LVAD speed. Conclusions The echocardiographic ramp test allowed LVAD speed adjustment and optimization and improved LV unloading during ramp testing and at final speed with no evidence of worsening of RV function.

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Section: Discussionsupporting

confidence: 93%

Validation of non‐invasive ramp testing for HeartMate 3

et al. 2020

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“…15 Consistent with our prior findings, speed optimization was able to normalize CVP and PCWP in 50% of patients with abnormal hemodynamics at baseline. All of these hemodynamic studies demonstrate a wide range of baseline hemodynamics with differing responses to speed changes, suggesting a significant benefit in performing speed optimization with the aid of simultaneous invasive hemodynamics.…”

Section: Invasive Hemodynamic Optimizationsupporting

confidence: 90%

Hemodynamic Pump-Patient Interactions and Left Ventricular Assist Device Imaging

et al. 2018

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“…Hemodynamic ramp testing was performed with therapeutic anticoagulation and no adverse events related to the RHC occurred. The utility of invasive ramp test is applicable to many devices and we recently reported ramp tests modified to HeartMate 3 and HeartAssist 5 patients [26,27]. Of note, the majority of patients supported with HeartMate 3 (62.5%) had normal CVP and PCWP at baseline speed, and the number with normal hemodynamics increased up to 81.3% after speed adjustment.…”

Section: Ramp Test and Optimization Of Hemodynamicsmentioning

confidence: 99%

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura

Chung

Nguyen

et al. 2018

Journal of Cardiology

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Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them. In this review, we will discuss the hemodynamic changes following LVAD implantation, and the implications and prognostic impact of hemodynamic optimization on outcomes and complications.

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Clinical hemodynamic evaluation of patients implanted with a fully magnetically levitated left ventricular assist device (HeartMate 3)

Abstract: Hemodynamic normalization of pressures was achieved in the majority of patients implanted with the HM3 pump within a narrow speed range.

Cited by 60 publications

References 14 publications

Validation of non‐invasive ramp testing for HeartMate 3

Validation of non‐invasive ramp testing for HeartMate 3

Hemodynamic Pump-Patient Interactions and Left Ventricular Assist Device Imaging

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

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