Abstract 17288: Low Pulsatility is Associated With Vasoplegic Syndrome in Heartmate II LVAD Explants During Heart Transplantation

Abstract

Introduction: Continuous flow-left ventricular assist devices (CF-LVAD) have been implicated as a risk factor for vasoplegic syndrome (VS) after orthotopic heart transplantation (OHT). Although a lack of pulsatility has been postulated as the cause, there is currently no data to support this hypothesis. Hypothesis: We hypothesized that low pulsatility as measured by the Pulsatility Index of HeartMate II CF-LVADs at OHT admission was associated with VS during CF-LVAD explant and OHT. Methods: A retrospective chart review of all adult patients that had underwent heart transplants at our center were reviewed from 2014-2017. VS was defined as a profound vasodilatory shock (SVR < 800 dyne/s/cm 5 ) despite persistent vasopressor support with a preserved cardiac index (≥ 2.2 L/min/m 2 ) occurring at any time between 6 and 48 hours post OHT. Pulsatility Index of HeartMate II CF-LVADs were obtained at the day of OHT admission. Results: A total of 103 patients underwent OHT during the 4-year study period. The median age was 57 (48-64) years, 29 (28%) were females, 75 (73%) had CF-LVAD. Overall 23 (22%) patients developed VS. As expected, VS was more prevalent in CF-LVAD explants compared to primary heart transplant (27% vs 11%, p=0.09). Mean Pulsatility Index in CF-LVAD explants with VS (n =20/75) was lower compared to CF-LVAD explants absent VS (n=55/75) (5.9 ± 1.1 vs 6.5 ± 0.9, p=0.03) (Figure 1). Multivariate logistic regression analysis of all pre-operative variables found BMI (OR 1.23, 95% CI 1.03-1.50; p=0.01) and Pulsatility Index (OR 0.43, 95% CI 0.19-0.94; p=0.03) as the only independent risk factors associated with VS among CF-LVAD explants patients post OHT. Conclusions: In conclusion, lower pulsatility index is associated with vasoplegic syndrome in HeartMate II CF-LVAD post OHT. This association warrants further investigation in order to develop strategies to avoid this complication.