Sacubitril-Valsartan Initiation Post-Left Ventricular Assist Device is Safe and Effective

Abstract

Introduction and Aim Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction includes demonstrated benefit from the combination drug sacubitril-valsartan in acute and chronic heart failure. However, little is known of its’ tolerability in patients with stage D HF requiring durable left ventricular assist device (LVAD) implantation. Our aim was to determine its’ safety and efficacy in patients with durable LVADs. Methods We retrospectively reviewed patients who were initiated on sacubitril-valsartan post-LVAD implantation at our institution for baseline characteristics and drug tolerability. Results We identified 10 patients with a mean age of 57.5 ± 8.7 years who were initiated on sacubitril-valsartan post-LVAD implantation, 80% for destination therapy. Of these, 4 had axial and 6 had centrifugal flow pumps. The majority were Caucasian (60%) and male (70%). The initiation of sacubitril-valsartan reduced MAP by 20.0 ± 14.0 mmHg (p=0.002), and NT-proBNP from 2,929 pg/mL to 1,530 pg/mL (p=0.36). By contrast, mean serum creatinine and potassium were unaltered (Table 1). Only one patient experienced hyperkalemia, and no patients developed drug-related acute kidney injury (decline in eGFR >25%), hypotension or angioedema. Following the initiation of sacubitril-valsartan, there was a concomitant reduction in the use of other oral vasodilators (30-50%), mineralocorticoid receptor antagonists (20%), and non-potassium sparing diuretics (10%). Conclusions Sacubitril-valsartan initiation in patients after LVAD implantation is tolerated, and reduces MAP. Elevated MAP has been related to adverse events post-LVAD and sacubitril-valsartan appears safe and effective in our preliminary experience in patients supported with continuous flow LVAD.