Post-Implant Beta-Blocker Use Is Associated With Decreased Rates of Late Right Heart Failure After Left Ventricular Assist Device

Senser, Ethan; Nunez, Jose I; Kennedy, Kevin; Kiernan, Michael S.; Sabe, Marwa; Garan, A.R.; Grandin, E. Wilson

doi:10.1016/s0735-1097(20)31615-6

Cited by 2 publications

(1 citation statement)

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“…27 Lower blood pressures could limit the use of traditional neurohormonal antagonists which have been associated with improved survival and quality of life 30 and lower rates of LRHF after LVAD. 31 In the UMC, ePDE5i patients had significantly lower rates of β-blocker and ACEi/ARB use at one month, potentially contributing to increased LRHF.…”

Section: Discussionmentioning

confidence: 98%

Outcomes With Phosphodiesterase-5 Inhibitor Use After Left Ventricular Assist Device: An STS-INTERMACS Analysis

Grandin

Gulati

Nunez

et al. 2022

Circ: Heart Failure

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Background: Elevated right ventricular afterload following continuous-flow left ventricular assist device (CF-LVAD) may contribute to late right heart failure (LRHF). PDE5i (phosphodiesterase-5 inhibitors) are used to treat pulmonary hypertension and right heart dysfunction after CF-LVAD, but their impact on outcomes is uncertain. Methods: We queried Interagency Registry for Mechanically Assisted Circulatory Support from 2012 to 2017 for adults receiving a primary CF-LVAD and surviving ≥30 days from index discharge. Patients receiving early PDE5i (ePDE5i) at 1 month were propensity-matched 1:1 with controls. The primary outcome was the cumulative incidence of LRHF, defined using prevailing Interagency Registry for Mechanically Assisted Circulatory Support criteria; secondary outcomes included all-cause mortality and major bleeding. Results: Among 9627 CF-LVAD recipients analyzed, 2463 (25.6%) received ePDE5i and 1600 were propensity-matched 1:1 with controls. Before implant, ePDE5i patients had more severe RV dysfunction (13.1% versus 9.6%) and higher pulmonary vascular resistance (2.8±2.7 versus 2.2±2.4 WU), both P <0.001, but clinical factors were well-balanced after propensity-matching. In the unmatched cohort, ePDE5i patients had a higher 3-year cumulative incidence of LRHF, mortality, and major bleeding, but these differences were attenuated in the propensity-matched cohort: LRHF 40.8% versus 35.7% (hazard ratio, 1.14 [95% CI, 0.99–1.32]; P =0.07); mortality 38.6% versus 35.8% (hazard ratio, 0.99 [95% CI, 0.86–1.15]; P =0.93); major bleeding 51.2% versus 46.0% (hazard ratio, 1.12 [95% CI, 0.99–1.27]; P =0.06). Conclusions: Compared with propensity-matched controls, adult CF-LVAD patients receiving ePDE5i had similar rates of LRHF, mortality, and major bleeding. While intrinsic patient risk factors likely account for more adverse outcomes with ePDE5i in the unmatched cohort, there is no obvious benefit of ePDE5i in the LVAD population.

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Section: Discussionmentioning

confidence: 98%

Outcomes With Phosphodiesterase-5 Inhibitor Use After Left Ventricular Assist Device: An STS-INTERMACS Analysis

Grandin

Gulati

Nunez

et al. 2022

Circ: Heart Failure

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New Advances in Medical Management of Left Ventricular Assist Devices Recipients

Racharla,

Sidhu,

Vidula

2024

Curr Treat Options Cardio Med

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Purpose of Review The purpose of this review is to discuss medical management of patients with left ventricular assist devices (LVADs) and to summarize recent advancements, specifically focusing on medications for anticoagulation, blood pressure, and heart failure. Recent Findings Omission of aspirin in LVAD recipients is not associated with an increased risk of pump thrombosis, stroke, or peripheral arterial thromboembolism. Early data from small studies suggest that direct oral anticoagulants can be safely used in patients with the newer generation HeartMate 3 devices. Data supports a mean arterial blood pressure goal of 75-90 mmHg, with avoidance of hypotension. Finally, retrospective studies demonstrate that quadruple guideline-directed medical therapy can be used in patients on LVAD support without an increased risk of adverse events. Summary Management of LVAD patients is complex, requiring ongoing active decision-making for titration of medications. Larger studies of medical management are needed to further reduce the incidence of gastrointestinal bleeding, right ventricular failure, and increase the potential for myocardial recovery.

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Post-Implant Beta-Blocker Use Is Associated With Decreased Rates of Late Right Heart Failure After Left Ventricular Assist Device

Cited by 2 publications

References 0 publications

Outcomes With Phosphodiesterase-5 Inhibitor Use After Left Ventricular Assist Device: An STS-INTERMACS Analysis

Outcomes With Phosphodiesterase-5 Inhibitor Use After Left Ventricular Assist Device: An STS-INTERMACS Analysis

New Advances in Medical Management of Left Ventricular Assist Devices Recipients

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