Abstract 2363: Longer Duration of Continuous Flow Ventricular Assist Device Support Predicts Greater Hemodynamic Compromise with Return to Pulsatility
PURPOSE: To determine if duration of continuous flow ventricular assist device (CVAD) support is associated with greater pressor requirements after return to pulsatile flow.
METHODS: The study population included 44 consecutive patients undergoing heart transplant/VAD explant at a single institution–33 pulsatile flow VADs (PVAD) and 11 CVADs. Doses of continuously infused pressors were collected q24hrs for 7 days postop. The magnitude of pressor requirements was assessed using a composite pressor score (Table⇓) as well as number of concurrent pressors.
RESULTS: Unlike PVADs, among CVADs there was a direct and statistically significant relationship in univariate regression between duration of VAD support and pressor score at all time points. Median CVAD support duration was 94 days. When comparing pts with CVAD support > =94d (n=6) with those on
CVAD < 94d (n=11) or
PVAD > =94d, the > =94d CVADs had significantly higher pressor scores at most time points (Figure⇓) and required a greater number of concurrent pressors at all time points after the first 48 hrs.
There was no statistical difference in 30-day post-transplant mortality (p=0.73) between CVAD (n=1, 9.1%) and PVAD (n=2, 6.1%) groups.
CONCLUSIONS: Longer duration of CVAD is associated with increased duration and dose of pressor support with return to pulsatility. This observation may be related to CVAD physiology.