26 CardiomemsTM in VAD patients

Abstract

Successive generations of left ventricular assist devices (LVADs) have been associated with improvement in patient outcomes and reduction in device-related complications.1 Beyond mortality reduction, quality of life improvement and reduction in hospitalisation are increasingly focused upon. Following LVAD implantation, the number of admissions per year is highest in the first year.2 3 In fact, within 30–90 days, hospitalisation for volume overload – indicative of acute worsening heart failure, haemodynamically significant arrhythmias or imbalance of haemodynamics due to suboptimal LVAD pump settings – could account for 11%–24% of admissions.2 4 5 To improve our understanding of mechanisms related to VAD therapy, investigators have reviewed data from LVAD patients with pre-operatively placed implantable pulmonary artery pressure (PAP) monitors (CardioMEMSTM). Studies have shown that implantation of PAP monitors can assist in management of haemodynamics, thus potentially reducing hospitalisation in a portion of LVAD patients with volume overload. Although retrospective analyses of PAP monitor data suggested that PAP could be effectively reduced by LVAD implantation,6 there remains a lack of prospective data to support routine use of PAP monitoring in LVAD patients to guide haemodynamic management. In the ongoing Intellect2, a multi-centre prospective observational 6 month follow-up study of 100 LVAD patients (https://clinicaltrials.gov/ct2/show/NCT03247829), CardioMEMS will be evaluated for its effects on haemodynamics optimisation to impact on patients’ functional status, quality of life and hospital medications. References Mehra MR, Goldstein DJ, Uriel N, Cleveland JC Jr, Yuzefpolskaya M, Salerno C, Walsh MN, Milano CA, Patel CB, Ewald GA, Itoh A, Dean D, Krishnamoorthy A, Cotts WG, Tatooles AJ, Jorde UP, Bruckner BA, Estep JD, Jeevanandam V, Sayer G, Horstmanshof D, Long JW, Gulati S, Skipper ER, O’Connell JB, Heatley G, Sood P, Naka Y; MOMENTUM 3 Investigators. Two-Year Outcomes with a Magnetically Levitated Cardiac Pump in Heart Failure. N Engl J Med 2018;378:1386–1395. Tripathi B, Arora S, Kumar V, Thakur K, Lahewala S, Patel N, Dave M, Shah M, Savani S, Sharma P, Bandyopadhyay D, Shantha GPS, Egbe A, Chatterjee S, Patel NK, Gopalan R, Figueredo VM, Deshmukh A. Hospital complications and causes of 90-Day readmissions after implantation of left ventricular assist devices. Am J Cardiol 2018;122:420–430. Vidula H, Kutyifa V, Johnson BA, Strawderman RL, Harrington D, Polonsky B, Papernov A, Alexis JD. Readmission Patterns During Long-Term Follow-Up After Left ventricular assist device implantation. Am J Cardiol 2018;122:1021–1027. Gupta S, Cogswell RJ, Roy SS, Spratt JR, Liao KK, Martin CM, John R. Impact of 30 Day Readmission After Left Ventricular Assist Device Implantation. ASAIO J 2018 May 7. doi:10.1097/MAT.0000000000000812. Patel S, Poojary P, Pawar S, Saha A, Patel A, Chauhan K, Correa A, Mondal P, Mahajan K, Chan L, Ferrandino R, Mehta D, Agarwal SK, Annapureddy N, Patel J, Saunders P, Crooke G, Shani J, Ahmad T, Desai N, Nadkarni GN, Shetty V. National landscape of unplanned 30-day readmissions in patients with left ventricular assist device implantation. Am J Cardiol 2018;122:261–267. Feldman DS, Moazami N, Adamson PB, Vierecke J, Raval N, Shreenivas S, Cabuay BM, Jimenez J, Abraham WT, O’Connell JB, Naka Y. The utility of a wireless implantable hemodynamic monitoring system in patients requiring mechanical circulatory support. ASAIO J 2018;64:301–308.