Pulmonary function assessment post-left ventricular assist device implantation

Pavol Sajgalik, Chul Ho Kim, John M. Stulak, Sudhir S. Kushwaha, Simon Maltais, David Joyce, Lyle D. Joyce, Bruce D. Johnson, John A Schirger

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: The lungs—and particularly the alveolar-capillary membrane—may be sensitive to continuous flow (CF) and pulmonary pressure alterations in heart failure (HF). We aimed to investigate long-term effects of CF pumps on respiratory function. Methods and results: We conducted a retrospective study of patients with end-stage HF at our institution. We analysed pulmonary function tests [e.g. forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 )] and diffusing capacity of the lung for carbon monoxide (D LCO ) from before and after left ventricular assist device (LVAD) implantation and compared them with invasive haemodynamic studies. Of the 274 patients screened, final study analysis involved 44 patients with end-stage HF who had CF LVAD implantation between 1 February 2007 and 31 December 2015 at our institution. These patients [mean (standard deviation, SD) age, 50 (9) years; male sex, n = 33, 75%] received either the HeartMate II (Thoratec Corp.) pump (77%) or the HeartWare (HeartWare International Inc.) pump. The mean (SD) left ventricular ejection fraction was 21% (13%). At a median of 237 days post-LVAD implantation, we observed significant D LCO decrease (−23%) since pre-implantation (P < 0.001). ΔD LCO had an inverse relationship with changes in pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) from pre-LVAD to post-LVAD implantation: ΔD LCO to ΔPCWP (r = 0.50, P < 0.01) and ΔD LCO to ΔRAP (r = 0.39, P < 0.05). We observed other reductions in FEV 1 , FVC, and FEV 1 /FVC between pre-LVAD and post-LVAD implantation. In mean (SD) values, FEV 1 changed from 2.3 (0.7) to 2.1 (0.7) (P = 0.005); FVC decreased from 3.2 (0.8) to 2.9 (0.9) (P = 0.01); and FEV 1 /FVC went from 0.72 (0.1) to 0.72 (0.1) (P = 0.50). Landmark survival analysis revealed that ΔD LCO from 6 months after LVAD implantation was predictive of death for HF patients [hazard ratio (95% confidence interval), 0.60 (0.28–0.98); P = 0.03]. Conclusions: Pulmonary function did not improve after LVAD implantation. The degree of D LCO deterioration is related to haemodynamic status post-LVAD implantation. The ΔD LCO within 6 months post-operative was associated with survival.

Original languageEnglish (US)
Pages (from-to)53-61
Number of pages9
JournalESC Heart Failure
Volume6
Issue number1
DOIs
StatePublished - Feb 1 2019

Keywords

  • Continuous flow pumps
  • D
  • Pulmonary circulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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