Improved Quality of Life and Functional Performance Post-LVAD Surgery Using Hemodynamic Guided Optimization Pre-LVAD Surgery

Abstract

We assessed the effect of pre-operative hemodynamically optimization by CardioMEMS on the outcome of LVAD patients in relation to the quality of life (QoL) and functional performance. Ten consecutive chronic heart failure patients, with an INTERMACS Class 2-5, scheduled for (semi-) elective LVAD surgery were enrolled in the HEMO-VAD pilot study. The median age was 59.7 [52.4-63.0] years and 70.0% of patients were men. All patients received before LVAD surgery a CardioMEMS device on a median of 13.5 (range 3-23) days before surgery. The daily hemodynamic readings were used to guide the patient's optimization process. Aims of hemodynamically optimization were normalization of the mean pulmonary artery pressure (mPAP) and decongesting of the right ventricle and optimization of the renal function. In this analysis, we investigated the change in the quality of life (QoL) (according to the EQ-5D-5L, KCCQ, and PHQ-9 questionnaires) and 6-minute walking distance between baseline and 3 months of follow-up. The QoL improved in both groups between baseline and 3 months of follow-up, measured in all three questionnaires. Also the 6-minute walking distance improved significantly in both groups between baseline and 3 months of follow-up. Interestingly, the improvement in the EQ-5D-5L (+38.8±15.1 vs. +16.6±4.9) and 6-minute walking distance (+395.9±43.6 vs. +147.9±102.7) was bigger in patients who were hemodynamically optimized pre-LVAD surgery. QoL and functional performance improved in the first 3 months post-LVAD surgery. Patients who were hemodynamically optimized pre-LVAD surgery using the CardioMEMS seem to improve more in QoL and functional performance compared to those not hemodynamically optimized.