Safety and Effectiveness of Sacubitril/Valsartan in Patients with a Left Ventricular Assist Device

Purpose The purpose of this study was to evaluate the effectiveness and tolerability of angiotensin receptor-neprilysin inhibition with sacubitril/valsartan (S/V) in a large cohort of patients supported with a left ventricular assist device (LVAD). Methods This was a longitudinal, retrospective cohort study evaluating LVAD patients who were prescribed S/V at a single non-transplant center from January 2019 to September 2020. The primary objectives were to evaluate improvement in mean arterial pressure (MAP) and continued use without clinically significant adverse events. Concomitant medication changes at S/V initiation and reasons for S/V discontinuation were also evaluated. Continuous data were compared using paired t-tests. Results S/V was initiated in 46 patients (45% of all LVAD patients managed by the program) during the study period. Most patients were Black (30, 65%) males (30, 65%) supported as destination therapy (44, 96%). A total of 18 patients (39%) were converted to S/V from other renin-angiotensin inhibitors. Adjustments were made to concomitant blood pressure therapies in 31 patients (67%) upon initiation of S/V, primarily the discontinuation of non-goal directed therapies (Table 1). MAP was significantly reduced at 1, 3, and 6 months and at last follow-up (Figure 1). The average decrease in MAP at last follow-up was 12.2 mmHg (p Conclusion In the largest cohort of LVAD patients reported to date, S/V was shown to significantly and safely reduce blood pressure. S/V was well tolerated with no discontinuations for significant adverse events. Further prospective evaluation will confirm these results, assess opportunities for dosage titration, and determine if S/V is associated with improved clinical outcomes in LVAD patients.