Correction of Iron Deficiency with Intravenous Iron Replacement Immediately after Left Ventricular Assist Device Implant

Abstract

Iron deficiency anemia (IDA) persists after left ventricular assist device (LVAD) placement and is associated with increased hospitalizations and mortality. Correction of IDA with IV iron replacement in patients with heart failure improves quality of life (QoL), functional capacity, and reduces hospitalizations. Minimal data for IV iron replacement in patients with LVAD exists. We sought to assess the safety and efficacy of protocolized iron deficiency diagnosis and IV iron replacement in newly implanted LVAD recipients. A prospective, observational study of all patients undergoing LVAD implant from 1/1/2019-9/30/2019 was conducted. Iron studies were obtained in all patients prior to index discharge; iron deficiency was defined as ferritin <100 ng/mL or ferritin 100-299 ng/mL with transferrin saturation (TSat) <20%. Patients with IDA received ferric gluconate (FG) 250 mg IV q12h to correction of iron deficit as calculated by the Ganzoni formula. Iron studies were repeated in 4-8 weeks in the ambulatory setting. Functional capacity and QoL were evaluated by the change in 6-minute walk test (6MWT) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) pre-implant, compared to the 3 month follow up clinic visit, respectively. Of the 16 patients who received an LVAD in the study period, 12 (75%) were found to have IDA and received IV FG. Patients were 62±10 years old, 81% were male, and 50% were Caucasian. No infusion-related adverse effects occurred. At a median follow-up of 9.9 weeks, 87.5% were no longer iron deficient. Hemoglobin (HgB), hematocrit (HCT) and Tsat increased significantly; there was no difference in ferritin levels. For the 8 patients with a 3 month post-implant clinic visit, a significant increase in MLHFQ, but not 6MWT, was observed. IV FG infusions immediately after LVAD are well-tolerated and associated with increased HgB/HCT and correction of IDA. Future studies are needed to confirm improvement in clinical outcomes.