Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

• Published in: International journal of artificial organs Vol. 43; no. 7; pp. 452 - 460
• Main Authors: Schaefer, Jacob J, Sajgalik, Pavol, Kushwaha, Sudhir S, Olson, Lyle J, Stulak, John M, Johnson, Bruce D, Schirger, John A
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-07-2020; Wichtig Editore s.r.l
• Subjects: Aged; Blood pressure; Blood Pressure - physiology; Capillary pressure; Confidence intervals; Controllers; Diastolic pressure; Electronic devices; Female; Follow-Up Studies; Heart; Heart Failure - physiopathology; Heart Failure - therapy; Heart Ventricles - physiopathology; Heart-Assist Devices - adverse effects; Hemodynamics; Hospitalization; Humans; Implantation; Male; Middle Aged; Pulmonary arteries; Pulmonary artery; Pulsatile Flow - physiology; Retrospective Studies; Stroke Volume - physiology; Surgery; Systolic pressure; Unloading; Ventricle; pulsatility; morbidity; Pulmonary vascular pressure; re-hospitalization
• ISSN: 0391-3988; 1724-6040
• DOI: 10.1177/0391398819899403

HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = −.57, p < .01; r = −.38, p < .05; r = −.59, p < .01; r = −.47, p = .01 and r = −.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315–0.983), p = .04 and hazard ratio = .579 (0.341–0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.