Impact of plasma volume status on mortality following left ventricular assist device implantation

Abstract

Worsening systemic congestion is often the central trigger of hospitalization in patients with heart failure. However, accurate assessment of congestion is challenging. The prognostic impact of systemic congestion following durable continuous‐flow left ventricular assist device (LVAD) implantation remains unknown. Consecutive patients who received durable continuous‐flow LVAD implantation between January 2014 and June 2017 and were followed for 1 year were included. The association of preoperative plasma volume status, which was calculated using patients’ body weight and hematocrit and expressed as a deviation from ideal plasma volume, with 1‐year mortality following LVAD implantation was investigated. In total, 186 patients (median 57 years and 138 males) were included. Baseline plasma volume status was −30.1% (−37.1%, −19.4%) on median. Eighty‐eight patients (47%) had higher plasma volume status (>−29.8%), and their 1‐year survival was significantly lower than those without (67% vs. 87%, P = .001). High plasma volume status was an independent predictor of 1‐year death with an adjusted hazard ratio of 4.52 (95% confidence interval 1.52‐13.5). Baseline systemic congestion, as defined by the high plasma volume status, was associated with higher mortality following durable continuous‐flow LVAD implantation. The implication of improving preoperative plasma volume remains an area of needed investigation.

Association between Remote Dielectric Sensing and Estimated Plasma Volume to Assess Body Fluid Distribution

“…The methodology to estimate the PVS by using the Hakim formula, as a surrogate of systemic congestion, was demonstrated and validated by previous studies [ 8 , 9 ]. Its prognostic impact was demonstrated in cohorts of patients with severe aortic stenosis [ 12 ], ischemic heart disease requiring coronary artery bypass surgery [ 13 ], and advanced heart failure requiring a durable left ventricular assist device [ 14 ]. Given the clinical conditions where quantifying systemic congestion was observed to be feasible, we sought to estimate a comprehensive congestion profile in a cohort with a low likelihood of clinical congestion in addition to those who have a higher likelihood of a clinically abnormal congestion profile.…”

Calculated Plasma Volume Status Is Associated with Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

“…In an analysis of 3414 patients with heart failure with preserved ejection fraction, higher calculated estimates of PVS were independently associated with an elevated risk of long-term clinical outcomes, and particularly, heart failure hospitalization [ 20 ]. In an analysis of 186 patients who received a continuous-flow left ventricular assist device, high PVS was associated with higher mortality during follow-up [ 21 ].…”

Deviations From the Ideal Plasma Volume and Isolated Tricuspid Valve Surgery—Paving the Way for New Risk Stratification Parameters

“…Tamaki et al followed a group of patients admitted for acute decompensated heart failure and found that the plasma volume status correlated with overall mortality and rehospitalization for decompensated heart failure, findings similar to those of Yoshihisa et al (27,28). The value of PVS for risk stratification has been examined for a range of other applications, including left ventricular assist device (LVAD) recipients, coronary artery bypass grafting (CABG) or acute respiratory distress syndrome (ARDS) (29)(30)(31). Several studies have also looked at the potential of PVS for outcome and mortality prediction in patients undergoing interventions for valvular disease.…”