Normalisation of Haemodynamics in Patients with End-stage Heart Failure with Continuous-flow Left Ventricular Assist Device Therapy

Sunil Gupta; Kei Woldendorp; Kavitha Muthiah; Desiree Robson; Roslyn Prichard; Peter S Macdonald; Anne M Keogh; Eugene Kotlyar; Andrew Jabbour; Kumud Dhital; Emily Granger; Phillip Spratt; Paul Jansz; Christopher S Hayward

doi:10.1016/j.hlc.2014.04.259

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Normalisation of Haemodynamics in Patients with End-stage Heart Failure with Continuous-flow Left Ventricular Assist Device Therapy

Journal article

Peer reviewed

Normalisation of Haemodynamics in Patients with End-stage Heart Failure with Continuous-flow Left Ventricular Assist Device Therapy

Sunil Gupta, Kei Woldendorp, Kavitha Muthiah, Desiree Robson, Roslyn Prichard, Peter S Macdonald, Anne M Keogh, Eugene Kotlyar, Andrew Jabbour, Kumud Dhital, …

Heart, Lung & Circulation, Vol.23(10), pp.963-969

2014

DOI: https://doi.org/10.1016/j.hlc.2014.04.259

PMID: 24973864

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Abstract

Heart failure

Haemodynamics

Heart-assist devices

Pulmonary hypertension

Clinical outcomes

Left ventricular function

Background: New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF). Methods: We reviewed 53 consecutive patients (mean age 49.5 ± 14.1yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n = 35) and echocardiography (n = 39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support. Results: A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p < 0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4 mm (p < 0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 μmol/L (p < 0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n = 18) compared to those without (96.9%, n = 35, p = 0.01). Conclusions: HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term.

Details

Title: Normalisation of Haemodynamics in Patients with End-stage Heart Failure with Continuous-flow Left Ventricular Assist Device Therapy
Authors: Sunil Gupta (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Kei Woldendorp (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Kavitha Muthiah (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Desiree Robson (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Roslyn Prichard (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Peter S Macdonald (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Anne M Keogh (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Eugene Kotlyar (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Andrew Jabbour (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Kumud Dhital (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Emily Granger (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Phillip Spratt (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Paul Jansz (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Christopher S Hayward (Author) - Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia
Publication details: Heart, Lung & Circulation, Vol.23(10), pp.963-969
Publisher: Elsevier Australia
DOI: 10.1016/j.hlc.2014.04.259
ISSN: 1444-2892
PMID: 24973864
Organisation Unit: University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy; School of Health - Nursing
Language: English
Record Identifier: 99512708002621
Output Type: Journal article

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