Impaired Spirometry, but Not DLCO, is Associated with Risk of Death or Right Heart Failure Following LVAD Implantation

Abstract

Purpose Severe medical comorbidities are associated with poor outcomes after LVAD implantation. The association between preoperative pulmonary function and postoperative outcomes after LVAD implantation are unknown. Methods We analyzed LVAD recipients from our institution from 1/1/2015 to 2/28/2018 who had preoperative pulmonary function testing (PFT). We excluded patients bridged to LVAD with ECMO support. The primary outcome was the composite of death within 30 days, need for RVAD support within 30 days, or need for postoperative inotropic support beyond 14 days. We evaluated the association between the percent predicted values of forced expiratory volume in 1 second (FEV1pred), forced vital capacity (FVCpred) and diffusion capacity for carbon monoxide adjusted for hemoglobin (DLCO-Adjpred) and the primary outcome using univariable logistic regression. Results There were 102 patients with preoperative PFT data available. At baseline, 70 (69%) of patients had moderate or severe right ventricular (RV) dysfunction by echocardiography and 56 (55%) had moderate or severe tricuspid regurgitation (TR). Mean ± standard deviation of baseline PFT parameters were as follows: FEV1pred, 66.6% ± 14.7; FVCpred 67.4% ± 13.9; DLCO-Adjpred 56.7% ± 16.3. The primary outcome occurred in 43 (42%) patients. A 10 percentage point increase in baseline FEV1pred (OR 0.66, 95% CI 0.49-0.9, p Conclusion Reduced FEV1 and FVC were closely associated with risk of death or right heart failure. Whether preoperative spirometry adds incremental value to existing risk models requires further investigation. Specific thresholds should be investigated in larger multicenter cohorts.