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Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics.

Authors
  • Schaefer, Jacob J1
  • Sajgalik, Pavol1
  • Kushwaha, Sudhir S1
  • Olson, Lyle J1
  • Stulak, John M2
  • Johnson, Bruce D1
  • Schirger, John A1
  • 1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
  • 2 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Type
Published Article
Journal
The International Journal of Artificial Organs
Publisher
SAGE Publications
Publication Date
Jul 01, 2020
Volume
43
Issue
7
Pages
452–460
Identifiers
DOI: 10.1177/0391398819899403
PMID: 31984834
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = -.57, p < .01; r = -.38, p < .05; r = -.59, p < .01; r = -.47, p = .01 and r = -.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315-0.983), p = .04 and hazard ratio = .579 (0.341-0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.

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