Abstract

Purpose Continuous-flow left ventricular assist devices (LVAD) dramatically improve the hemodynamics of patients with advanced heart failure. However, longitudinal trends of hemodynamics in LVAD patients remain unknown. The aim of this study is to clarify the trends of hemodynamic parameters following LVAD implantation. Methods We retrospectively reviewed patients who received LVAD implantation between 4/2014-8/2018. We collected hemodynamic parameters obtained from right heart catheterization (RHC) prior to and following LVAD implantation. Results Among 199 consecutive patients, we enrolled 145 patients who had at least two RHCs. Each patient had a test before LVAD implantation, and an average of 2.2±1.4 RHCs after LVAD implantation during median 493 (15-1540) days of follow-up. Mean age was 57±13 years old and 101 patients (70%) were male. Following LVAD implantation, mean pulmonary arterial pressure (PAP) and pulmonary capillary wedge pressure (PCWP) decreased significantly and remained lower throughout LVAD course. Cardiac Index (CI) increased significantly and remained higher throughout LVAD course (Figure 1A). Right atrial pressure (RAP) improved initially and then returned to pre-implant values. Pulmonary artery pulsatility index (PAPi) did not improve early after implantation (3.0±2.7 to 2.7±2.1, P=1.00), and then progressively decreased over longer follow-up periods (2.3±3.6 at 1-2 years and 1.5±0.5 at 2-3 years) (Figure 1B). Conclusion Despite improvement in left-side filling pressure following LVAD implantation, PAPi worsened over time suggesting progressive right ventricular dysfunction.

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