Abstract 3128: Complete Discontinuation of Mechanical Support for Monitoring Recovery in Patients with Left Ventricular Assist Devices
Assessment of myocardial recovery during Left Ventricular Assist Device (LVAD) support is difficult to perform safely and effectively. We have developed a method of completely discontinuing mechanical assist with haemodynamic monitoring whilst performing echocardiography at rest and whenever possible after exercise.
Methods: Following full heparinisation, the HeartMate I XVE LVAD was switched off completely (hand-pumping every 5 seconds to prevent blood stagnation inside the pump) with haemodynamic and echocardiographic measurements at the time of switching off, after 5 and 15 minutes and if tolerated after a six-minute walk for inotropic reserve. Measurements included mean arterial blood pressure (MAP), heart rate (HR), EF, LVDD, and LVSD. First assessment was performed four weeks after implantation and repeated at monthly intervals.
Results: A total of 192 On/Off pump tests were performed on 20 patients. 15 of these showed sufficient myocardial recovery and the device was explanted (recovered group; duration of support 373.3±239.3 days). The remaining 5 were transplanted (non-recovered group; duration of support 551.2±176 days). 122 echoes were performed in the 15 recovered patients and on 7 occasions (5.7%) the patients were unable to exercise due to vertigo in 4, chest pain in 2 and shortness of breath in 1. 70 tests were performed in the 5 non-recovered patients who were unable to exercise on 12 occasions (17.1%) due to vertigo in 2, shortness of breath in1, lethargy in 8 and abdominal pain in 1. MAP dropped by 25.3% in the non-recovered group compared to 0.3% in the recovered group post exercise (table⇓). HR increased by 36.5% in the non-recovered group compared to 26.7% in the recovered group (table⇓).
Conclusion: Evaluation of recovery using complete cessation of LVAD support is a safe and effective method in monitoring recovery. Haemodynamics parameters.