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. 2022 Mar 1;68(3):325-332.
doi: 10.1097/MAT.0000000000001465.

Optimal Hemodynamics and Risk of Severe Outcomes Post-Left Ventricular Assist Device Implantation

Andrew N Rosenbaum  1   2 , Bradley W Ternus  3 , John M Stulak  4 , Alfredo L Clavell  1   2 , Sarah D Schettle  4 , Atta Behfar  1   2   5 , Jacob C Jentzer  1
Affiliations

Optimal Hemodynamics and Risk of Severe Outcomes Post-Left Ventricular Assist Device Implantation

Andrew N Rosenbaum et al. ASAIO J. .

Abstract

Data on pre-implant hemodynamic optimization before continuous flow left ventricular assist device placement (CF-LVAD) with respect to patient-centered outcomes remain limited. Consecutive patients undergoing CF-LVAD implant between 2007 and 2017 were identified. Hemodynamic variables, trends, and laboratory studies were evaluated pre-LVAD implant in a logistic regression model to identify predictors of the primary composite endpoint: the need for right ventricular assist device therapy, the requirement for hemodialysis at 90 days, and 30-day mortality. Multivariate modeling identified three variables significantly associated with the primary endpoint: right ventricular stroke work index (RVSWI), right atrial pressure (RAP), and blood urea nitrogen (BUN); all immediately pre-LVAD, p < 0.01. Optimal dichotomization points were 500 mmHg*ml*m-2, 12 mmHg, and 40 mg/dL. The three-component model identified an AUC of 0.77 (p < 0.0001) for the composite endpoint. Optimization of 2/3 parameters, 1/3, and 0/3 was associated with odds ratios of 3.5 (95% CI, 1.1-11.7), 7.2 (95% CI, 2.1-24.2), and 20.6 (95% CI, 5.3-80.6), respectively, relative to those patients who were fully optimized (3/3 parameters). The number of optimized parameters was also associated with 1-year overall survival (p = 0.02). Low RVSWI, high RAP, and high BUN were independently associated with adverse outcomes after the CF-LVAD implant, demonstrating a stepwise association with severe postimplant adverse events.

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Conflict of interest statement

Disclosure: Dr Behfar is a cofounder and is on the Board of Directors of Rion LLC. He holds stock in Sorento Therapeutics and shares in Deverra Therapeutics. The other authors have no conflicts of interest to report.

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