Longitudinal Trajectories of Hemodynamics Following Left Ventricular Assist Device Implantation

Abstract Background : Continuous-flow left ventricular assist devices (LVADs) improve the hemodynamics of patients with advanced heart failure. However, longitudinal trajectories of hemodynamics in LVAD patients remain unknown. The aim of this study was to investigate the trends of hemodynamic parameters following LVAD implantation. Methods and Results : We retrospectively reviewed patients who underwent LVAD implantation between 4/2014 and 8/2018. We collected hemodynamic parameters from right heart catheterizations (RHCs). Among 199 consecutive patients, we enrolled 150 patients who had both pre- and post-implant RHCs. They had 3 (2, 4) post-implant RHCs during follow-up of 2.3 (1.3, 3.1) years. Mean age was 57±13 years and 102 patients (68%) were male. Following LVAD implantation, pulmonary arterial pressure and pulmonary capillary wedge pressure decreased and cardiac index increased significantly, and then remained unchanged throughout follow-up. Right atrial pressure (RAP) decreased initially, and then gradually increased to pre-implant values. Pulmonary artery pulsatility index (PAPI) decreased initially and returned to pre-implant values, and then progressively decreased over longer follow-up. Subgroup analysis showed significant differences in the trajectories of PAPI based on gender. Conclusions : Despite improvement in left-side filling pressures and cardiac index following LVAD implantation, RAP increased and PAPI decreased over time suggesting progressive right ventricular dysfunction.