(578) - Poor Pre-Operative Pulmonary Function Tests (PFTs) Do Not Predict Worse Outcomes in Patients Undergoing LVAD Placement

Abstract

Poor preoperative pulmonary function has been identified as a risk factor for poor outcomes following cardiac surgery, but this has not been well described in patients undergoing LVAD placement. The objective is to examine the relationship between preoperative pulmonary function and outcomes after LVAD implantation. We evaluated patients who underwent HeartMate II as intent for BTT at a single center from 10/2005 to 7/2014. Moderate to severe obstructive pulmonary disease was defined as a forced expiratory volume in 1s (FEV1) to forced vital capacity ratio (FEV1/FVC) <0.7 and FEV1 <80%. 183 patients were evaluated; of these, 122 had preoperative PFTs; 61 patients had PFTs deferred due to heart failure exacerbation. Of these 122 patients, 47 had moderate to severe obstructive PFTs (group 1) and 75 patients had normal to mild obstructive PFTs. The mean % predicted FEV1 was 56 ± 12L in group 1 and 72± 17L (p = 0.001) in group 2. The FEV1/FVC ratio was 0.63 ± 0.1 in group 1 and 0.80 ± 0.05 in group 2 (p = 0.0001). There were no significant differences in age, etiology, gender, INTERMACS profiles, or baseline hemodynamics (p = NS). Patients in group 1 were significantly more likely to have a smoking history (64% vs 35%, p =0.03) higher pack years of smoking (39 vs 23, p = 0.02), and prior history of COPD (23% vs 5%, 0.004). There was no significant differences in days of ventilation, reintubation, right heart failure, ICU length of stay, length of stay, or LVAD duration of support between group 1 or 2 (p = NS). Actuarial survival at 1 year was 81% in group 1 and 89.5% in group 2 (log rank p = NS). Patients with moderate to severe obstruction on PFTs prior to LVAD placement do not have worse outcomes than those patients with normal PFTs. In patients with end-stage heart failure, poor pulmonary function may be a reflection of decompensated heart failure. Therefore, poor PFTS should not be considered an absolute contraindication to LVAD placement.