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Cardiopulmonary Testing in patients with Heartmate 3 Left Ventricular Assist Device
Session:
Posters - D. Heart Failure
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; Bruno Rocha; Sérgio Maltês; Catarina Brízido; Christopher Strong; António Ventosa; António Tralhão; Carlos Aguiar; Luís Moreno; Anai Durazzo; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:#333333">Background: </span></strong><span style="color:#222222">Functional capacity measured by NYHA functional class and Cardiopulmonary Stress Testing (CPET) is routinely assessed in patients with Heart Failure (HF) previous to Left Ventricular Assist Device (LVAD) implantation. We aimed to evaluate the serial changes in exercise capacity before and following long-term LVAD implantation. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:#333333">Methods: </span></strong> <span style="color:#222222">We describe a case series of patients who underwent a HeartMate 3<sup>TM</sup> (Abbott, IL) LVAD implantation as bridge to transplant in our center. CPET was performed at baseline, for decision regarding HeartMate 3<sup>TM</sup> implantation, 2-3 months after the procedure, at the time of inclusion in the Cardiac Rehabilitation (CR) Program and at the end of the CR program, after approximately 4 months. Individual 9-panel plot CPET tracings at pre- and post-LVAD implantation were assessed, including the peak oxygen uptake (pVO<sub>2</sub>), </span><span style="color:black">minute ventilation/carbon dioxide production (VE/VCO<sub>2</sub>), as well as the presence of exercise oscillatory ventilation (EOV).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:#333333">Results: </span></strong><span style="color:#333333"> Three patients were evaluated (</span><strong><span style="color:#0070c0">Table 1</span></strong><span style="color:#333333">), all of whom had advanced HF (NYHA III-IV<sub>a</sub>, LVEF <25%, INTERMACS 4, and recurrent HF hospitalizations) and were treated with a </span><span style="color:#222222">HeartMate 3<sup>TM</sup> LVAD</span><span style="color:#333333"> as bridge to transplant. All patients had been previously enrolled in CR before device implantation, and all resumed CR following device implantation. Serial clinical, laboratory and CPET evaluation demonstrates a meaningful improvement in all cases, shortly after discharge and during ambulatory follow-up, namely reduction in NYHA class, levels of NT-pro-BNP and VE/VO2 slope, increase in peak VO2 consumption and disappearance of exercise oscillatory ventilations (EOV) (</span><strong><span style="color:#0070c0">figure 1, Table 2</span></strong><span style="color:#333333">). There were only minimal adjustments (± 0-100rpm) in </span><span style="color:#222222">HeartMate 3<sup>TM</sup> LVAD </span><span style="color:#333333">parameters between evaluations. There were no hospitalizations for HF nor were there any adverse events during CPET, home-based and/or center-based CR. Currently, all patients are enlisted and await heart transplantation</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:#333333">Conclusions: </span></strong><span style="color:#333333"> Our preliminary results show that CPET is a feasible and safe procedure in HF patients supported by a Heartmate 3 LVAD. HF guideline-directed treatment combined with a LVAD pump and CR were associated with a subjective and objective improvement, not only in the early post-LAVD implantation period, but also in the long term. </span></span></span></p>
Slides
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