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The Effect of Exercise and Resistance Training on Physical Capacity of LVAD Patients - Analysis of Different Age Groups
S226
The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
and 10.6±2.4 mmHg (p= 0.08). The differences between Doppler and SBP across CV100 success categories were -3.2±5.4, -4.2±3.5, -5.3±5.4 and -4.1±2.3 (p= 0.95). Conclusion: Doppler BP consistently approximates SBP regardless of CV100 success and PP. Doppler BP approximates MAP only when BP measurement by auto monitor fails and this is likely due to low PP in these pts.
6( 08) Development of Pulmonary Hypertension in Patients With LeftVentricular Assist Devices: Are Frequent Hemodynamic Assessments While on Transplant List Really Necessary? R.J. Kalathiya ,*1 B.A. Houston,2 J. Chaisson,1 G.R. Stevens,2 C. Sciortino,3 G.J. Whitman,3 A.S. Shah,3 S.D. Russell,2 R.J. Tedford.2 1Department of Medicine, Johns Hopkins Hospital, Baltimore, MD; 2Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD; 3Department of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD. 6( 07) Ability to Obtain Blood Pressure Readings By Standard Automated Blood Pressure Monitor Helps Interpreting the Relationship Between Doppler Blood Pressure to Systolic Blood Pressure and Mean Arterial Pressure P.C. Colombo ,1 K. Orlanes,2 G. Lanier,3 M. Yuzefpolskaya,1 M. Flannery,2 R. Te-Frey,2 Y. Hayashi,1 K. Wong,1 M.M. Ahmad,1 D.M. Mancini,1 N. Uriel,4 U.P. Jorde,5 V.K. Topkara,1 K. Takeda,2 H. Takayama,2 Y. Naka,2 R.T. Demmer.6 1Medicine, Columbia University, New York, NY; 2Surgery, Columbia University, New York, NY; 3Medicine, Westchester Medical Center, Valhalla, NY; 4Medicine, University of Chicago, Chicago, IL; 5Medicine, Montefiore Medical Center, Bronx, NY; 6Epidemiology, Columbia University, New York, NY. Purpose: Doppler ultrasound is routinely used to assess BP in ContinuousFlow Left Ventricular Assist Device (CF-LVAD) pts. However, the relationship of Doppler BP to systolic BP (SBP) and mean arterial pressure (MAP) remains controversial and has been shown to vary by pulse pressure (PP). Standard automated BP monitors are accurate but their success rate is low due to reduced PP. We tested a novel, simple approach to interpret the relationship between Doppler BP and both SBP and MAP based on success (ie, ability to provide a reading) by standard BP monitor. Methods: Arterial line (A-line), Doppler and GE CARESCAPE™ V100 (CV100) automated monitor BP measurements were made in triplicate in 30 CF LVAD HeartMate II pts (age 60±13yrs). Pts were categorized according to the number of successful CV100 readings (out of 3 readings). The difference between Doppler BP and either A-line SBP or A-line MAP was calculated for each pt. Mean differences were then compared across the 4 categories of pts defined by the number of successful CV100 readings. PP was also compared across these groups. Results: The % of pts with 0, 1, 2 or 3 successful CV100 measures were 17%, 22%, 15%, 46%, respectively. 100% of Doppler and A-line measures were successful. Mean Doppler, MAP, SBP, DBP and PP across CV100 success categories are presented in the Figure. Mean±STDERR PP increased across CV100 success categories as follows: 8±5, 16±1, 20±7 and 24±2 mmHg (p< 0.01). The mean±STDERR differences between Doppler and MAP across CV100 success categories were 2.0±5.8, 4.9±3.8, 6.2±5.8
Purpose: Current guidelines recommend right heart catheterization (RHC) every 3-6 months in patients listed for heart transplantation to allow for detection of hemodynamic changes that would increase the transplant risk, most notably the development of pulmonary hypertension (PH). Because patients with left-ventricular assist devices (LVAD) must be anticoagulated, frequent RHC in these patients carries an increased risk of bleeding complications. Our objective was to determine how frequently patients with LVADs develop PH that may alter transplant decisions. Methods: We retrospectively reviewed all patients who underwent HeartMate II LVAD implantation between 2005 and 2012. Of the 131 patients reviewed, we identified 73 patients who lived at least 1 year with an LVAD and had at least 2 post-LVAD hemodynamic assessments by RHC. We defined combined post-capillary and pre-capillary pulmonary hypertension (CpcPH) as mean pulmonary artery pressure (mPAP) > = 25mmHg and pulmonary vascular resistance (PVR) > 3.5 Wood units. Results: Of these 73 patients, 8 showed evidence of CpcPH on initial postLVAD hemodynamic assessment (median time: 55 days; IQR [22 to 84]). The 65 patients without CpcPH at the first post-LVAD RHC underwent an average of 2.7 right heart catheterizations over a median follow up period of 1.5 years (IQR [1.0 to 2.3]). Importantly, only 1 of these 65 patients had evidence of CpcPH (mPAP 40mmg, PVR 4.9 WU) over the entire follow-up period, and this patient had resolution of CpcPH on follow up RHC 3 months later without pharmacologic intervention. Conclusion: Patients who undergo LVAD implantation and have no evidence of CpcPH on initial post-LVAD RHC are at minimal risk of developing PH during their time on LVAD therapy. Given the risk of procedural complications while on anticoagulation and concern for pump thrombosis if anticoagulation is withheld, screening RHC in this population is not warranted. 6( 09) The Effect of Exercise and Resistance Training on Physical Capacity of LVAD Patients - Analysis of Different Age Groups N. Reiss ,*1 P. Bartsch,1 M. Altesellmeier,1 A. Workowski,1 S. Schulte-Eistrup,1 H. Warnecke,1 J. Schmitto,2 A. Haverich,2 D. Willemsen.1 1Schuechtermann Clinic Bad Rothenfelde, Bad Rothenfelde, Germany; 2Medizinische Hochschule, Hannover, Germany.
Abstracts S227 Purpose: Left ventricular assist devices (LVAD) are increasingly implanted in older patients with terminal heart failure as destination therapy. The aim of the present study was to evaluate whether there are differences in the response to exercise and resistance training in LVAD patients < 50 years and > 50 years during early cardiac rehabilitation. Methods: This retrospective single-centre case study integrated data from 100 LVAD patients. Patients were divided into two groups (group 1: LVAD patients < 50 years; n= 35, mean age 37.8 years; group 2: LVAD patients > 50 years; n= 65, mean age 59.4 years). 6-minute-walk test (6-MWT) and maximal isometric strength of musculus quadriceps femoris (MQF) evaluated using both legs assessment were performed at beginning and end of cardiac rehabilitation in both groups. 36 LVAD patients (11 patients of group 1; 25 patients of group 2) qualified for additional spiroergometry because of 6-minute-walk (6-MWT) result and their clinical conditions. For statistical analysis we used t-test for paired samples. Results: The distance of 6-MWT increased significantly in both groups (group 1: T1 336 ±101.5 m vs. T2 424.7±101.8 m, group 2 T1 264.4±104.4 m vs. T2 353.5±95.4 m; p< 0.001). The maximal isometric strength of the MQF also improved significantly in both groups (group 1: T1 389.9±257.4 Nm vs. T2: 512.5±260.4 Nm; p< 0.001; group 2: 351.7±142.5 Nm vs. T2: 447.7±187.8 Nm; p< 0.001). Spiroergometry showed a mean peak VO2/kg of 11.24 ml/min*kg (33.2% predicted) in group 1 and a mean peak VO2/kg of 8.75 ml/min*kg (34.6% predicted) in group 2. Conclusion: The results demonstrate a safe and effective implementation of moderate exercise and resistance training for LVAD-patients in both age groups. Both groups showed a significant improvement of physical capacity during early cardiac rehabilitation. Nevertheless, there were no significant differences regarding the extent of improvement in patients < or > 50 years. 6( 10) Hemodynamic Performance and Early Clinical Result, EVAHEART and HeartMate II Y. Matsumoto ,1 T. Fujita,1 H. Hata,1 Y. Shimahara,1 S. Sato,1 O. Seguchi,2 T. Nakatani,2 J. Kobayashi.1 1Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Suita, Japan; 2Transplantation, National Cerebral and Cardiovascular Center, Osaka, Suita, Japan. Purpose: This study aims to compere the hemodynamic performance and early clinical results of the EVAHEART (EH, Sun Medical Technology Research Co, JAPAN) and HeartMate II (HMII, Thoratec Corp, Pleasanton, CA). Methods: From 2007 to 2014, 104 patients underwent LVAD implantation at our center, 14 patients received EH and 25 received HMII. Early survival, freedom from exit site infection and neurological event were evaluated with Kaplan-Meier method. Hemodynamic performance was evaluated by transthoracic echocardiography at postoperative 1, 3, 6 months and right heart catheter at 1 month. Results: Follow up rate was 100%. Survival rates were comparable between these two devices and survival rates at 24 month were 85.7% with EH and 100% with HMII (p= 0.19). NYHA functional class for EH/HMII were significantly decreased (p< 0.01) for both devices to 1.4/1 at 6 month. HMII was significantly better for freedoms from exit site infection (p= 0.049, 46.2% with EH and 85% with HMII at 12 month), and for freedom from neurological events (p< 0.01, 28.6% with EH and 87% with HMII at 12 month). BNP levels (pg/ml) were significantly reduced (p< 0.01) for both devices, and there was no significant difference between these devices. LDH level (U/l) was significantly lower with EH (p= 0.034, 224±68 with EH and 361±118 with HMII at 6 month). LVDd regression rate (%) was significantly greater with HMII (p= 0.007, -7.8±6.6 with EH and -22.8±18.1 with HMII at 6 month). The increase of EF (%) from base lines was not statistically difference between two devices but HMII showed tendency to obtain additional improvement (p= 0.171, 0.7±13.8% with EH and 7.7±14.4% with HMII). Postoperative catheter examination showed that HMII provided significantly lower PCWP (p< 0.01, 11.2±4.9mmHg with EH and 4.9±2.9mmHg with HMII) and mean PA pressure (p< 0.01, 22±5.7mmHg with EH and 14.7±3.9mmHg with HMII) were significantly lower in patients with HMII, despite of comparable RA pressure (p= 0.09, 7.5±2.7mmHg with EH and 5.0±3.6mmHg with HMII). Conclusion: Both devices provided excellent survival rates and hemodynamics. HMII may be better to elude clinical adverse events. Steep H-Q curve of
HMII may create additional suction of pump and provide more reduction of LV size. However, the additional effects of HMII for LV reverse remodeling or benefit for right heart failure by reducing right ventricular afterload should be carefully analyzed with more cases. 6( 11) Similar Pressure and Volume Unloading With Different Geometrical Changes Between HVAD and HMII Detected During Hemodynamics 3D Echo Ramp Studies N. Uriel ,1 G.T. Sayer,1 K. Addetia,1 S. Fedson,1 K. Collins,1 G. Kim,1 E. Kruse,1 C. Juricek,2 D. Rodgers,1 T. Ota,2 V. Jeevanandam,2 R. Lang.1 1Medicine, University of Chicago, Chicago, IL; 2Surgery, University of Chicago, Chicago, IL. Purpose: Differences in how intra-abdominal axial flow pumps (HMII) and intra-thoracic centrifugal flow pumps (HVAD) unload the left ventricle (LV) when assessed by 2D echocardiography have been noted by several groups. The aim of this study was to compare the extent of LV unloading and differences in LV shape in response to speed changes between HMII and HVAD using geometry-independent measures of LV unloading. Methods: Consecutive patients with CF-LVAD underwent RPM ramp tests with simultaneous recording of right heart catheterization (RHC) parameters and 3 Dimentional echo with post processing surface analysis. RHC data pulmonary capillary wedge pressure (PCWP), Fick Cardiac output (CO), and 3D echo assessment of LV and RV volume. Ramp tests were done with increments of 400 RPMs (8000-12000 rpm) for HMII patients and with 100 RPMs (2300-3200 rpm) for HVAD patients. Results: Both HM II and HVAD reduced the PCWP in response to speed changes (1.8±1 vs 1.1±0.3 for each speed increment p= 0.226). 2D LVEDD slope decreased significantly with the HMII, but not with the HVAD (-0.17 vs -0.04, p= 0.14). However, 3D surface analysis revealed that both devices reduced global LV volume similarly (82±32 vs 73±5 ml, p= 0.4) but that changes LV shape differed between devices. LV shape changes were evident in every level of the heart in HMII patients but with HVAD, changes were noted only in the area of the apex. (figure). Conclusion: Both axial and continuous flow pumps unload the LV. However, changes in LV volume are manifest differently between HMII and HVAD. Those changes are hypothesized to be related to the intra-abdominal location of HMII compared with the intra-thoracic placement of HVAD. This study also indicates that ramp studies aimed at understanding ventricular unloading are best performed with geometry-independent parameters such as PCWP and LVV.
6( 12) Outcomes and Predictors of 30-Day and Long-Term Mortality in Case of Cardiopulmonary Resuscitation Requiring Extracorporeal Life Support in the Elderly M. Pontailler , P. Demondion, G. Lebreton, P. Leprince. Department of Thoracic & Cardio-Vascular Surgery, Pitié Salpêtrière Hospital, Paris, France.
The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
and 10.6±2.4 mmHg (p= 0.08). The differences between Doppler and SBP across CV100 success categories were -3.2±5.4, -4.2±3.5, -5.3±5.4 and -4.1±2.3 (p= 0.95). Conclusion: Doppler BP consistently approximates SBP regardless of CV100 success and PP. Doppler BP approximates MAP only when BP measurement by auto monitor fails and this is likely due to low PP in these pts.
6( 08) Development of Pulmonary Hypertension in Patients With LeftVentricular Assist Devices: Are Frequent Hemodynamic Assessments While on Transplant List Really Necessary? R.J. Kalathiya ,*1 B.A. Houston,2 J. Chaisson,1 G.R. Stevens,2 C. Sciortino,3 G.J. Whitman,3 A.S. Shah,3 S.D. Russell,2 R.J. Tedford.2 1Department of Medicine, Johns Hopkins Hospital, Baltimore, MD; 2Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD; 3Department of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD. 6( 07) Ability to Obtain Blood Pressure Readings By Standard Automated Blood Pressure Monitor Helps Interpreting the Relationship Between Doppler Blood Pressure to Systolic Blood Pressure and Mean Arterial Pressure P.C. Colombo ,1 K. Orlanes,2 G. Lanier,3 M. Yuzefpolskaya,1 M. Flannery,2 R. Te-Frey,2 Y. Hayashi,1 K. Wong,1 M.M. Ahmad,1 D.M. Mancini,1 N. Uriel,4 U.P. Jorde,5 V.K. Topkara,1 K. Takeda,2 H. Takayama,2 Y. Naka,2 R.T. Demmer.6 1Medicine, Columbia University, New York, NY; 2Surgery, Columbia University, New York, NY; 3Medicine, Westchester Medical Center, Valhalla, NY; 4Medicine, University of Chicago, Chicago, IL; 5Medicine, Montefiore Medical Center, Bronx, NY; 6Epidemiology, Columbia University, New York, NY. Purpose: Doppler ultrasound is routinely used to assess BP in ContinuousFlow Left Ventricular Assist Device (CF-LVAD) pts. However, the relationship of Doppler BP to systolic BP (SBP) and mean arterial pressure (MAP) remains controversial and has been shown to vary by pulse pressure (PP). Standard automated BP monitors are accurate but their success rate is low due to reduced PP. We tested a novel, simple approach to interpret the relationship between Doppler BP and both SBP and MAP based on success (ie, ability to provide a reading) by standard BP monitor. Methods: Arterial line (A-line), Doppler and GE CARESCAPE™ V100 (CV100) automated monitor BP measurements were made in triplicate in 30 CF LVAD HeartMate II pts (age 60±13yrs). Pts were categorized according to the number of successful CV100 readings (out of 3 readings). The difference between Doppler BP and either A-line SBP or A-line MAP was calculated for each pt. Mean differences were then compared across the 4 categories of pts defined by the number of successful CV100 readings. PP was also compared across these groups. Results: The % of pts with 0, 1, 2 or 3 successful CV100 measures were 17%, 22%, 15%, 46%, respectively. 100% of Doppler and A-line measures were successful. Mean Doppler, MAP, SBP, DBP and PP across CV100 success categories are presented in the Figure. Mean±STDERR PP increased across CV100 success categories as follows: 8±5, 16±1, 20±7 and 24±2 mmHg (p< 0.01). The mean±STDERR differences between Doppler and MAP across CV100 success categories were 2.0±5.8, 4.9±3.8, 6.2±5.8
Purpose: Current guidelines recommend right heart catheterization (RHC) every 3-6 months in patients listed for heart transplantation to allow for detection of hemodynamic changes that would increase the transplant risk, most notably the development of pulmonary hypertension (PH). Because patients with left-ventricular assist devices (LVAD) must be anticoagulated, frequent RHC in these patients carries an increased risk of bleeding complications. Our objective was to determine how frequently patients with LVADs develop PH that may alter transplant decisions. Methods: We retrospectively reviewed all patients who underwent HeartMate II LVAD implantation between 2005 and 2012. Of the 131 patients reviewed, we identified 73 patients who lived at least 1 year with an LVAD and had at least 2 post-LVAD hemodynamic assessments by RHC. We defined combined post-capillary and pre-capillary pulmonary hypertension (CpcPH) as mean pulmonary artery pressure (mPAP) > = 25mmHg and pulmonary vascular resistance (PVR) > 3.5 Wood units. Results: Of these 73 patients, 8 showed evidence of CpcPH on initial postLVAD hemodynamic assessment (median time: 55 days; IQR [22 to 84]). The 65 patients without CpcPH at the first post-LVAD RHC underwent an average of 2.7 right heart catheterizations over a median follow up period of 1.5 years (IQR [1.0 to 2.3]). Importantly, only 1 of these 65 patients had evidence of CpcPH (mPAP 40mmg, PVR 4.9 WU) over the entire follow-up period, and this patient had resolution of CpcPH on follow up RHC 3 months later without pharmacologic intervention. Conclusion: Patients who undergo LVAD implantation and have no evidence of CpcPH on initial post-LVAD RHC are at minimal risk of developing PH during their time on LVAD therapy. Given the risk of procedural complications while on anticoagulation and concern for pump thrombosis if anticoagulation is withheld, screening RHC in this population is not warranted. 6( 09) The Effect of Exercise and Resistance Training on Physical Capacity of LVAD Patients - Analysis of Different Age Groups N. Reiss ,*1 P. Bartsch,1 M. Altesellmeier,1 A. Workowski,1 S. Schulte-Eistrup,1 H. Warnecke,1 J. Schmitto,2 A. Haverich,2 D. Willemsen.1 1Schuechtermann Clinic Bad Rothenfelde, Bad Rothenfelde, Germany; 2Medizinische Hochschule, Hannover, Germany.
Abstracts S227 Purpose: Left ventricular assist devices (LVAD) are increasingly implanted in older patients with terminal heart failure as destination therapy. The aim of the present study was to evaluate whether there are differences in the response to exercise and resistance training in LVAD patients < 50 years and > 50 years during early cardiac rehabilitation. Methods: This retrospective single-centre case study integrated data from 100 LVAD patients. Patients were divided into two groups (group 1: LVAD patients < 50 years; n= 35, mean age 37.8 years; group 2: LVAD patients > 50 years; n= 65, mean age 59.4 years). 6-minute-walk test (6-MWT) and maximal isometric strength of musculus quadriceps femoris (MQF) evaluated using both legs assessment were performed at beginning and end of cardiac rehabilitation in both groups. 36 LVAD patients (11 patients of group 1; 25 patients of group 2) qualified for additional spiroergometry because of 6-minute-walk (6-MWT) result and their clinical conditions. For statistical analysis we used t-test for paired samples. Results: The distance of 6-MWT increased significantly in both groups (group 1: T1 336 ±101.5 m vs. T2 424.7±101.8 m, group 2 T1 264.4±104.4 m vs. T2 353.5±95.4 m; p< 0.001). The maximal isometric strength of the MQF also improved significantly in both groups (group 1: T1 389.9±257.4 Nm vs. T2: 512.5±260.4 Nm; p< 0.001; group 2: 351.7±142.5 Nm vs. T2: 447.7±187.8 Nm; p< 0.001). Spiroergometry showed a mean peak VO2/kg of 11.24 ml/min*kg (33.2% predicted) in group 1 and a mean peak VO2/kg of 8.75 ml/min*kg (34.6% predicted) in group 2. Conclusion: The results demonstrate a safe and effective implementation of moderate exercise and resistance training for LVAD-patients in both age groups. Both groups showed a significant improvement of physical capacity during early cardiac rehabilitation. Nevertheless, there were no significant differences regarding the extent of improvement in patients < or > 50 years. 6( 10) Hemodynamic Performance and Early Clinical Result, EVAHEART and HeartMate II Y. Matsumoto ,1 T. Fujita,1 H. Hata,1 Y. Shimahara,1 S. Sato,1 O. Seguchi,2 T. Nakatani,2 J. Kobayashi.1 1Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Suita, Japan; 2Transplantation, National Cerebral and Cardiovascular Center, Osaka, Suita, Japan. Purpose: This study aims to compere the hemodynamic performance and early clinical results of the EVAHEART (EH, Sun Medical Technology Research Co, JAPAN) and HeartMate II (HMII, Thoratec Corp, Pleasanton, CA). Methods: From 2007 to 2014, 104 patients underwent LVAD implantation at our center, 14 patients received EH and 25 received HMII. Early survival, freedom from exit site infection and neurological event were evaluated with Kaplan-Meier method. Hemodynamic performance was evaluated by transthoracic echocardiography at postoperative 1, 3, 6 months and right heart catheter at 1 month. Results: Follow up rate was 100%. Survival rates were comparable between these two devices and survival rates at 24 month were 85.7% with EH and 100% with HMII (p= 0.19). NYHA functional class for EH/HMII were significantly decreased (p< 0.01) for both devices to 1.4/1 at 6 month. HMII was significantly better for freedoms from exit site infection (p= 0.049, 46.2% with EH and 85% with HMII at 12 month), and for freedom from neurological events (p< 0.01, 28.6% with EH and 87% with HMII at 12 month). BNP levels (pg/ml) were significantly reduced (p< 0.01) for both devices, and there was no significant difference between these devices. LDH level (U/l) was significantly lower with EH (p= 0.034, 224±68 with EH and 361±118 with HMII at 6 month). LVDd regression rate (%) was significantly greater with HMII (p= 0.007, -7.8±6.6 with EH and -22.8±18.1 with HMII at 6 month). The increase of EF (%) from base lines was not statistically difference between two devices but HMII showed tendency to obtain additional improvement (p= 0.171, 0.7±13.8% with EH and 7.7±14.4% with HMII). Postoperative catheter examination showed that HMII provided significantly lower PCWP (p< 0.01, 11.2±4.9mmHg with EH and 4.9±2.9mmHg with HMII) and mean PA pressure (p< 0.01, 22±5.7mmHg with EH and 14.7±3.9mmHg with HMII) were significantly lower in patients with HMII, despite of comparable RA pressure (p= 0.09, 7.5±2.7mmHg with EH and 5.0±3.6mmHg with HMII). Conclusion: Both devices provided excellent survival rates and hemodynamics. HMII may be better to elude clinical adverse events. Steep H-Q curve of
HMII may create additional suction of pump and provide more reduction of LV size. However, the additional effects of HMII for LV reverse remodeling or benefit for right heart failure by reducing right ventricular afterload should be carefully analyzed with more cases. 6( 11) Similar Pressure and Volume Unloading With Different Geometrical Changes Between HVAD and HMII Detected During Hemodynamics 3D Echo Ramp Studies N. Uriel ,1 G.T. Sayer,1 K. Addetia,1 S. Fedson,1 K. Collins,1 G. Kim,1 E. Kruse,1 C. Juricek,2 D. Rodgers,1 T. Ota,2 V. Jeevanandam,2 R. Lang.1 1Medicine, University of Chicago, Chicago, IL; 2Surgery, University of Chicago, Chicago, IL. Purpose: Differences in how intra-abdominal axial flow pumps (HMII) and intra-thoracic centrifugal flow pumps (HVAD) unload the left ventricle (LV) when assessed by 2D echocardiography have been noted by several groups. The aim of this study was to compare the extent of LV unloading and differences in LV shape in response to speed changes between HMII and HVAD using geometry-independent measures of LV unloading. Methods: Consecutive patients with CF-LVAD underwent RPM ramp tests with simultaneous recording of right heart catheterization (RHC) parameters and 3 Dimentional echo with post processing surface analysis. RHC data pulmonary capillary wedge pressure (PCWP), Fick Cardiac output (CO), and 3D echo assessment of LV and RV volume. Ramp tests were done with increments of 400 RPMs (8000-12000 rpm) for HMII patients and with 100 RPMs (2300-3200 rpm) for HVAD patients. Results: Both HM II and HVAD reduced the PCWP in response to speed changes (1.8±1 vs 1.1±0.3 for each speed increment p= 0.226). 2D LVEDD slope decreased significantly with the HMII, but not with the HVAD (-0.17 vs -0.04, p= 0.14). However, 3D surface analysis revealed that both devices reduced global LV volume similarly (82±32 vs 73±5 ml, p= 0.4) but that changes LV shape differed between devices. LV shape changes were evident in every level of the heart in HMII patients but with HVAD, changes were noted only in the area of the apex. (figure). Conclusion: Both axial and continuous flow pumps unload the LV. However, changes in LV volume are manifest differently between HMII and HVAD. Those changes are hypothesized to be related to the intra-abdominal location of HMII compared with the intra-thoracic placement of HVAD. This study also indicates that ramp studies aimed at understanding ventricular unloading are best performed with geometry-independent parameters such as PCWP and LVV.
6( 12) Outcomes and Predictors of 30-Day and Long-Term Mortality in Case of Cardiopulmonary Resuscitation Requiring Extracorporeal Life Support in the Elderly M. Pontailler , P. Demondion, G. Lebreton, P. Leprince. Department of Thoracic & Cardio-Vascular Surgery, Pitié Salpêtrière Hospital, Paris, France.