HVAD Lavare Cycle Reduces Cerebrovascular Events and Improves Survival

Abstract

<h3>Purpose</h3> The Lavare Cycle (LC) is a pre-programmed speed modulation algorithm in the HVAD device designed to automatically increase both ventricular and pump washing<b>.</b> The ReVOLVE trial suggested a reduction in adverse outcomes including stroke. We assessed the effect LC ON compared to LC OFF on HVAD implants. <h3>Methods</h3> We conducted a retrospective, single center study from 4/2017 to 6/2020 including all 46 patients who received a HVAD implant. The LC became available to our center on 06/2018. For the majority of patients LC was turned on at the time of implant admission. The primary endpoints were cerebrovascular events (CVE) by INTERMACS definition and survival between LC ON versus LC OFF. Secondary endpoints were GI bleeding and pump thrombosis rates. <h3>Results</h3> Fourty six patients (median age 57 years, 78% male, 58% non-ischemic cardiomyopathy) were implanted with HVAD device from 4/2017 to 6/2020. The median duration of HVAD support was 648 (245-902) days. The LC was activated in 33/46 patients. Median time to cycle activation in the LC ON group from implantation was, median (IQR): 4 (1-36) days. The LC ON group experienced less incidence of CVEs, with 6/33 (18%) in the ON vs. OFF 6/13 (46%), p=0.04 (Fig 1A). The median time of CVE from implant was for LC ON and OFF 223 and 104 days, respectively. Survival was significantly improved in the LC ON 31/33 (94%) vs OFF 7/13 (54%), p=0.003 (Fig 1B). There were however 7/33 GI bleeding events in the ON group while zero events in the OFF, p=0.08. Pump thrombosis events were equal rate in the ON 3/33 (9%) vs OFF 1/13 (8%), p=0.43. <h3>Conclusion</h3> LC ON was associated with a significant lower number of CVE (p =0.04) and better survival (p=0.003). The important impact of speed modulation on reducing neurologic events should be confirmed in a larger HVAD patient population.