Prospective evaluation of ventricular assist device risk scores’ capacity to predict cardiopulmonary exercise parameters

Dorken-Gallastegi, Ander; Öztürk, Pelin; Demir, Emre; Engin, Çağatay; Nalbantgil, Sanem; Yağdı, Tahir; Özbaran, Mustafa

doi:10.1093/icvts/ivz248

Cited by 5 publications

(7 citation statements)

References 24 publications

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“…28 CPET parameters improve but do not reach normal levels following LVAD implantation. 7,29,30 In line with the literature, there was a trend toward improvement in all exercise metrics measured in this study. Despite having poorer preimplantation values, the descending aorta group achieved very similar results following implantation in measures of ventilatory efficiency (VE/vCO 2 Slope) and oxygen uptake efficiency (OUES).…”

Section: Discussionsupporting

confidence: 90%

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Exercise capacity following ventricular assist device implantation via thoracotomy with outflow cannula anastomosis to the descending aorta

et al. 2021

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Left ventricular assist device (LVAD) implantation via left lateral thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative technique that avoids anterior mediastinal planes and requires a single incision. This study compares changes in exercise capacity following LVAD implantation with outflow cannula anastomosis to the descending aorta versus ascending aorta. Adult patients who received a continuous flow centrifugal LVAD implantation and completed both pre‐ and postimplantation cardiopulmonary exercise tests (CPETs) and or 6‐minute walk tests (6MWT) were included. Change in CPET parameters (maximum oxygen intake: vO2max, oxygen uptake efficiency ratio: OUES, ventilatory efficiency ratio: vE/vCO2Slope) and 6MWT distance were compared between ascending and descending aorta anastomosis groups. Ascending and descending aorta anastomosis cohorts included 59 and 14 patients, respectively. Pre‐ and postimplantation CPETs were performed 63 ± 12 days before and 216 ± 17 days following implantation. The improvement in CPET parameters (vO2max, OUES, vE/vCO2Slope) or 6MWT distance was not significantly different between the ascending and descending aorta anastomosis groups. This study found no significant difference in the improvement of CPET parameters or 6MWT distance between LVAD implantation via thoracotomy with outflow cannula anastomosis to descending aorta and standard implantation via sternotomy with outflow cannula anastomosis to ascending aorta.

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Section: Discussionsupporting

confidence: 90%

“…CPET parameters improve but do not reach normal levels following LVAD implantation 7,29,30 . In line with the literature, there was a trend toward improvement in all exercise metrics measured in this study.…”

Section: Discussionsupporting

confidence: 90%

Exercise capacity following ventricular assist device implantation via thoracotomy with outflow cannula anastomosis to the descending aorta

et al. 2021

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“…For this comparison it is noteworthy that most patients are too frail to even perform exercise capacity testing pre-LVAD. In patients able to perform exercise capacity testing prior to LVAD, one study reported significant increase in pVO 2 after LVAD implantation whereas another reported no significant changes in pVO 2 after implantation (20,21).…”

Section: Clinical Observations During Exercisementioning

confidence: 99%

“…Due to the still unclear picture of maximal and submaximal exercise tests, pre-and/or post-LVAD implantation, further studies have been conducted (34,39,40). Exercise test results and their potential for risk stratification would provide important clinical insights (17,21,41). For possible LVAD device adjustments or changes in medical therapy, exercise test results might be helpful as proposed in Corrà et al (17).…”

Section: Submaximal Vs Maximal Exercisementioning

confidence: 99%

Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations

Fresiello

Gross

Jacobs

2021

Ann Cardiothorac Surg

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Left ventricular assist devices (LVADs) assure longer survival to patients, but exercise capacity is limited compared to normal values. Overall, LVAD patients show high wedge pressure and low cardiac output during maximal exercise, a phenomenon hinting at the need for increased LVAD support. Clinical studies investigating the hemodynamic benefits of an LVAD speed increase during exercise, ended in inhomogeneous and sometimes contradictory results. The native ventricle-LVAD interaction changes between rest and exercise, and this evolution is complex, multifactorial and patient-specific. The aim of this paper is to provide a comprehensive overview on the patient-LVAD interaction during exercise and to delineate possible therapeutic strategies for the future. A computational cardiorespiratory model was used to simulate the hemodynamics of peak bicycle exercise in LVAD patients. The simulator included the main cardiovascular and respiratory impairments commonly observed in LVAD patients, so as to represent an average hemodynamic response to exercise. In addition, other exercise responses were simulated, by tuning the chronotropic, inotropic and vascular functions, and implementing aortic regurgitation and stenosis in the simulator. These profiles were tested under different LVAD speeds and LVAD pressure-flow characteristics.Simulations output showed consistency with clinical data from the literature. The simulator allowed the working condition of the assisted ventricle at exercise to be investigated, clarifying the reasons behind the high wedge pressure and poor cardiac output observed in the clinics. Patients with poorer inotropic, chronotropic and vascular functions, are likely to benefit more from an LVAD speed increase during exercise.Similarly, for these patients, a flatter LVAD pressure-flow characteristic can assure better hemodynamic support under physical exertion. Overall, the study evidenced the need for a patient-specific approach on supporting exercise hemodynamics. In this frame, a complex simulator can constitute a valuable tool to define and test personalized speed control algorithms and strategies.

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“…Thus, it should be more often used in patients with both heart and lung diseases. The aim of this review is to get insight into the viability of cardiopulmonary exercise testing and to summarize the clinical applications in heart failure patients [1] as well as to demonstrate the utility in patients as candidates for LVAD implantation and explantation [2].…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Exercise Test in heart failure: A Sine qua non

Sakellaropoulos

Lekaditi

Svab

2020

Int. J. Phys. Educ. Fit. Sports

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A robust literature, over the last years, supports the indication of cardiopulmonary exercise testing (CPET) in patients with cardiovascular diseases. Understanding exercise physiology is a crucial component of the critical evaluation of exercise intolerance. Shortness of breath and exercise limitation is often treated with an improper focus, partly because the pathophysiology is not well understood in the frame of the diagnostic spectrum of each subspecialty. A vital field and research area have been cardiopulmonary exercise test in heart failure with preserved/reduced ejection fraction, evaluation of heart failure patients as candidates for LVAD-Implantation, as well as for LVAD-Explantation and ultimately for heart transplantation. All the CPET variables provide synergistic prognostic discrimination. However, Peak VO2 serves as the most critical parameter for risk stratification and prediction of survival rate.

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Prospective evaluation of ventricular assist device risk scores’ capacity to predict cardiopulmonary exercise parameters

Cited by 5 publications

References 24 publications

Exercise capacity following ventricular assist device implantation via thoracotomy with outflow cannula anastomosis to the descending aorta

Exercise capacity following ventricular assist device implantation via thoracotomy with outflow cannula anastomosis to the descending aorta

Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations

Cardiopulmonary Exercise Test in heart failure: A Sine qua non

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