Abstract 21574: Physical Performance of Outpatients Support by a Novel Lvad System
LVAD support as destination therapy and prolonged bridge to transplant for patients with heart failure has become a clinical reality. We were analysing the outcome and physical performance of patients being implanted with the new HeartWare HVAD for chronic support.
Methods: The HVAD left ventricular assist device was implanted into 60 consecutive patients with terminal heart failure at one institution. All patients were on catecholamine support prior to implant. In 12 patients venoarterial ECMO was already used for circulatory support prior to LVAD implantation. Survival, adverse events and physical performance were measured in these patients.
Results: Hospital survival was 90% in this patient cohort. All surviving patients were discharged and followed up for survival and adverse events. One year survival was 83%. No removal of device occurred during the first year for recovery or heart transplantation. Main adverse events were multiorgan failure for the perioperative period (n=6). Causes of deaths were cerebral events in 2 patients and pump thrombosis in one patient during the first year after implant. Percutaneous lead infection occurred in 16% of patients. Consent was obtained in 45 patients and in 46 aged-matched untrained controls (C) for assessment of physical performance in incremental exercise tests and in steps per day. In patients peak oxygen consumption was reduced (17±4 ml<zmd>min−1<zmd>kg−1; C: 33±12 ml<zmd>min−1<zmd>kg−1; p<0.01). Increase of blood lactate concentration in P started between 28 and 37 watts (C: between 80 and 100 watts) as a sign of low aerobic function of skeletal muscle. Steps per day were reduced in P (5034±3369 counts; C: 11579±4770 counts; p<0.01).
Conclusions: Excellent survival was observed in a patient cohort treated with the HeartWare HVAD as a left ventricular assist device for patients with end stage heart failure. Adverse events rates were similar to other modern devices of second and third generation. In the range of daily life requirements, exercise tests indicate that patients are not limited by cardiac performance after implantation of the VAD, but by skeletal muscular deconditioning. The progress of muscular deconditioning may become an indication for earlier implantation of assist devices for chronic left ventricular support.
- © 2010 by American Heart Association, Inc.