Utility of Routine Serum LDH After HeartMate 3 Left Ventricular Assist Device Implantation

Abstract

<h3>Purpose</h3> This study aims to evaluate the fluctuation of serum Lactate Dehydrogenase (LDH) in patients who are post-HeartMate 3 (HM3) Left Ventricular Assist Device (LVAD) implantation and to determine if routine monitoring of serum LDH values has changed management of patients, outcomes, or detected any pump thrombosis events. <h3>Methods</h3> This is a retrospective cohort study reviewing the electronic medical records of forty-eight HM3 LVAD patients at a tertiary care center in New Jersey, USA with implant dates ranging from 2017 to 2021. For each of these patients, serum LDH values were obtained including baseline values pre-implantation as well as fixed points in time post-operatively, specifically one week, one month, three months, six months, one year, one and a half years, and two years post-implantation as applicable for each patient. Each abnormal LDH value underwent further chart analysis to see if there was any change in clinical status, outcomes, management, or pump thrombosis event. An abnormal serum LDH value was defined as greater than 2.5 times the upper limit of normal, which has been standard practice to evaluate for pump thrombosis and/or hemolysis. <h3>Results</h3> Chart review of forty-eight HM3 LVAD patients showed that routine monitoring of serum LDH values did not change clinical outcomes or management of patients. Forty-six out of forty-eight patients did not have any recorded serum LDH value greater than 2.5 times the upper limit of normal post-implantation. The two patients with elevated serum LDH values post-operatively were never stable enough to be discharged from the hospital and expired shortly after implantation. There was also a 0% rate of pump thrombosis. <h3>Conclusion</h3> Routine monitoring of serum LDH in patients who are post-HM3 LVAD implantation does not change management or outcomes in asymptomatic patients. Therefore, ending routine monitoring of serum LDH eliminates unnecessary blood draws for patients and could represent a savings in healthcare costs as well as resources.