Effect of Early Post-Operative Intravenous Iron Replacement in Patients with HeartMate III

Purpose Iron deficiency is a common contributor to morbidity and mortality in patients with heart failure (HF). While guidelines suggest intravenous (IV) iron to improve functional status and quality of life (QoL) in patients with NYHA class II-III HF, left ventricular assist device (LVAD) recipients were not included in early IV iron studies. Small, recent studies show benefit of IV iron after LVAD, but iron replacement occurred months after device placement. Our study compares outcomes between patients who did and did not receive IV iron during the index admission following Thoratec HeartMate III® (HM 3) LVAD placement Methods Sixty-six adult patients with a HM 3 placed at our institution who received early post-op IV ferric gluconate (n=20) or no IV iron replacement (n=46) were compared. Patients who received other IV iron replacement within 90 days before or after LVAD placement were excluded. The co-primary outcomes were mean change in health-related quality of life (by the Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and 6 minute walk distance (6MWD) from baseline to first ≥ 90 day clinic follow-up. Resolution of iron deficiency and hemoglobin levels were also assessed in the IV iron group. Results Baseline characteristics were similar between groups (Table 1). The median baseline MLHFQ was 80 and 62 and 6MWD was 500 and 218 feet in the IV iron group and no IV iron groups, respectively. There was no significant difference between the IV iron and no-IV iron groups in MLHFQ (-27 ± 38 vs -29 ± 43, p = 0.262) or 6MWD (360 ± 740 vs. 607 ± 923, p = 0.118). Patients’ 6MWD increased on average by 360 ± 740 feet in the IV iron group compared to 606.5 ± 923 feet in those not receiving iron. Iron deficiency resolved in 17 (85%) patients who received IV iron. Conclusion Despite a high rate of resolution of IV iron deficiency, patients receiving IV iron during index admission following HM 3 implantation did not experience an improvement in quality of life or functional capacity when compared to those who did not receive IV iron.