Complete Versus Partial LV Unloading after LVAD Implantation and Association with Outcomes

Abstract

Background LVAD implantation improves survival in end-stage heart failure (HF) patients. It is unclear at this time whether the goal of partial or complete left ventricle (LV) unloading is the best long-term strategy to maintain favorable outcomes especially when it relates to patients who received LVAD as destination therapy. Methods We conducted a retrospective analysis of end-stage HF patients who underwent continuous-flow LVAD implantation and subsequent right heart catheterization (RHC) to determine partial or complete LV unloading using invasive hemodynamics. Complete LV unloading was defined as cardiac index (CI) > 2.2 and pulmonary capillary wedge pressure (PCWP) Results Our sample size included 142 patients. Mean age 57.4 (range 25-79), 75.5% of male gender and 55% had an ischemic etiology of HF. Complete LV unloading was seen in 52 (36.6%) patients compared to 90 (63.4%) patients with partial LV unloading. There was a trend towards worse outcomes (mortality and HF readmission) in the group with partial LV unloading, however, did not reach statistical significance ( Table 1 ). Discussion Although there was a trend towards worse 1-year outcomes in patients with partial LV unloading, this did not reach statistical significance. Our institution uses invasive hemodynamics based on RHC for LVAD speed optimization and alterations in LVAD speed done at the time of RHC may potentially have played a role in influencing outcomes of the partially unloaded LV group and hence not met statistical significance. Best long-term strategy for LV unloading remains unclear at this time and further studies are needed to guide management to maintain favorable long-term outcomes.