Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

Abstract

HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = −.57, p < .01; r = −.38, p < .05; r = −.59, p < .01; r = −.47, p = .01 and r = −.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315–0.983), p = .04 and hazard ratio = .579 (0.341–0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

“…18–20 This hypothesis was strengthened by the log-file analysis, which showed a decreasing trend in HVAD flow and a significant decrease in HVAD pulsatility in csOGO(+) patients. 3,20–23 Interestingly, we observed a significantly lower HVAD flow at admission for intra-pump thrombosis in the OGO(+) group. In other words, the expected increase in calculated HVAD flow due to the friction induced increase of power consumption caused by the intra-pump thrombosis was lower in patients who developed an acute OGO associated with lysis therapy.…”

Factors influencing the functional status of aortic valve in ovine models supported by continuous‐flow left ventricular assist device

“…As displayed in Figure 9, during AVC, the left ventricle and CF‐LVAD can work in series model (Figure 9B); a significant change in the aortic valve hemodynamics was observed secondary to the pulsatile flow generated from natural ventricular contraction and aortic root pressure 3,13 . It has been established that AVC is associated with arterial pulsatility weakening, vascular wall remodeling, increased inflammatory reaction, gastrointestinal bleeding, and aortic insufficiency (AI) 14–17 . Dobarro et al reported that AVC could cause a decrease in the overall survival rate in patients supported with CF‐LVAD, inducing damage to the left ventricle 18 .…”