Longitudinal analysis of pump parameters over long-term support with the HeartMate 3 left ventricular assist device.
| Autor: | Consolo F; Università Vita Salute San Raffaele, Milano., Pieri M; Università Vita Salute San Raffaele, Milano.; Department of Anesthesia and Intensive Care, Cardiothoracic Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan., Pazzanese V; Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan., Scandroglio AM; Department of Anesthesia and Intensive Care, Cardiothoracic Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan., Pappalardo F; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of cardiovascular medicine (Hagerstown, Md.) [J Cardiovasc Med (Hagerstown)] 2023 Oct 01; Vol. 24 (10), pp. 771-775. Date of Electronic Publication: 2023 Jun 30. |
| DOI: | 10.2459/JCM.0000000000001522 |
| Abstrakt: | Aims: Recurrence of heart failure emerged as the main cause of long-term mortality in patients implanted with the HeartMate 3 (HM3) left ventricular assist device (LVAD). We aimed at deriving a possible mechanistic rationale of clinical outcomes and analyzed longitudinal changes in pump parameters over prolonged HM3 support to investigate long-term effects of pump settings on left ventricular mechanics. Methods: Data on pump parameters (i.e. pump speed, estimated flow, and pulsatility index) were prospectively recorded in consecutive HM3 patients following postoperative rehabilitation (baseline) and then at 6, 12, 24, 36, 48, and 60 months of support. Results: Data of 43 consecutive patients were analyzed. Pump parameters were set according to regular patients' follow-up, including clinical and echocardiographic assessment. We recorded a significant progressive increase in pump speed over the course of support: from 5200 (5050-5300) rpm at baseline to 5400 (5300-5600) rpm at 60 months of support ( P = 0.0007). Consistently with the increase in pump speed, a significant increase in pump flow ( P = 0.007) and a decrease in pulsatility index ( P = 0.005) were also recorded. Conclusion: Our results reveal unique features of the HM3 on left ventricular activity. The need for progressive increase in pump support suggests indeed a lack of recovery and worsening of left ventricular function, which emerge as a possible mechanistic rationale of heart failure related mortality in HM3 patients. New algorithms to optimize pump settings should be envisioned to further improve LVAD-LV interaction and, ultimately, clinical outcomes in the HM3 population. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03255928. Clinicaltrialsgov Identifier: NCT03255928. (Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.) |
| Databáze: | MEDLINE |
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