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Central Venous Pressure as a Predictor of Outcome in Left Ventricular Assist Device (LVAD) Patients
The 11th Annual Scientific Meeting LDH in LVAD patients
J 2000 HeartMate II
Initial
Day 2
Day 4
Week 1
Week 2
Month 1
342.08 302.67
450.46 430.19
527.97 440.11
652.24 575.84
902.21 408.41
621.97 379.65
174 Central Venous Pressure as a Predictor of Outcome in Left Ventricular Assist Device (LVAD) Patients Gian Carlo Giove1, Luis Alberton1, Khouri Yasan1, Biswajit Kar1; 1Heart Transplant, Texas Heart Institute, Houston, TX Background: Left Ventricular assist devices (LVADs) are mechanical pumps that take over the function of the damaged ventricle and restore normal hemodynamics and end-organ blood flow. Outcomes with LVADs continue to be less that expected. There is no conclusive data published that relates hemodynamic parameters with LVAD implantation outcomes. For this reason we compared the relation between the HeartMate II and the Jarvik 2000 LVADs with the Central Venous Pressure (CVP) prior and posterior to the implantation of the LVAD. Method: We retrospectively compared common pre- LVAD clinical characteristics as well as Post-implantation values. In this study 36 patients with a HeartMate II and 35 with a Jarvik 2000 were included. Patients were divided in two groups depending on the average CVP values of the first 3 postoperative days. The outcomes were analyzed and compared. The CVP cut-off was set on 13mmHg. Results: Patients with a CVP of more than 13mmHg during the first three post-operative days had clearly not only a higher mortality rate but also a bigger morbidity. They had smaller number of days of pump support -149 days- compared to the 206 days of the second group (p ! 0.005). A lower number of Re-operations after implantation are also observer (1.6 vs. 1.3; p ! 0.05) Patients with a higher CVP have a 35% increase chance of dying within the first month of the implantation of the pump (p ! 0.05). There was a decrease of 15% in the rate of re-hospitalizations in patients with lower values of CVP. Higher CVP values were also correlated with higher hepatic enzymatic values. Lower blood pressures and bigger pulmonary wedge pressures are also observed. No significant difference was observed between the results in both pumps. Conclusion: The results of this study clearly show the relation between LVAD outcomes and the value of the CVP on the first days after the pump implantation.
175 The Effect of Continues Force on Myocardium Local Geometric and Dynamics Lea Lak1, Amir Sherman1, Michal Lipperman1, Amit Tubishevits1, Yael BenShabat1, Remo Almog1, Boaz Nishri1; 1CorAssist Cardiovascular, Herzliya, Israel Introduction: Diastolic heart failure (DHF) accounts for 30% to 55% of heart failure cases, resulting in significant mortality and morbidity. Management of DHF is empirical, limited, and disappointing. A new passive mechanical device (the IMCARDIA) was designed to treat DHF, by transferring a mechanical energy from LV systole phase to diastole phase. The supplement energy reduces the work that the blood needs to apply on the LV during the diastole and reduces the pressure. The device is composed of Attachment Screws (AS) which penetrates 1/2 -2/3 of the myocardium, Elastic Elements (EE) which positioned on the external surface of the LV.The EE applies continues force on the myocardium via the AS which its impact is unknown. Our aim is to study the effect of the device force on the myocardium local geometric and dynamics characteristics, and their implications on the device performance. Methods: The device was implanted on the beating heart of twelve healthy sheep for up to 170 days FU. Local epicardial strain and length were calculated using x-ray images processing. The EE applied force was calculated using superposition based analytical model that had been developed. Results: During the first 40 days the device force caused local tissue creeping which led to degradation of the device force. Thereafter, the tissue creeping stopped (Figure 1). In spite of the tissue creeping, the local strain remained unchanged during all FU period and as a result, the energy that the device had transferred into the LV during the diastole phase didn’t decrease (Figure 2). Conclusion: This study demonstrates that a passive mechanical device, which applied constant force on the myocardium, can be safely implanted without performance degradation due to the tissue creeping.
HFSA
S125
J 2000 HeartMate II
Initial
Day 2
Day 4
Week 1
Week 2
Month 1
342.08 302.67
450.46 430.19
527.97 440.11
652.24 575.84
902.21 408.41
621.97 379.65
174 Central Venous Pressure as a Predictor of Outcome in Left Ventricular Assist Device (LVAD) Patients Gian Carlo Giove1, Luis Alberton1, Khouri Yasan1, Biswajit Kar1; 1Heart Transplant, Texas Heart Institute, Houston, TX Background: Left Ventricular assist devices (LVADs) are mechanical pumps that take over the function of the damaged ventricle and restore normal hemodynamics and end-organ blood flow. Outcomes with LVADs continue to be less that expected. There is no conclusive data published that relates hemodynamic parameters with LVAD implantation outcomes. For this reason we compared the relation between the HeartMate II and the Jarvik 2000 LVADs with the Central Venous Pressure (CVP) prior and posterior to the implantation of the LVAD. Method: We retrospectively compared common pre- LVAD clinical characteristics as well as Post-implantation values. In this study 36 patients with a HeartMate II and 35 with a Jarvik 2000 were included. Patients were divided in two groups depending on the average CVP values of the first 3 postoperative days. The outcomes were analyzed and compared. The CVP cut-off was set on 13mmHg. Results: Patients with a CVP of more than 13mmHg during the first three post-operative days had clearly not only a higher mortality rate but also a bigger morbidity. They had smaller number of days of pump support -149 days- compared to the 206 days of the second group (p ! 0.005). A lower number of Re-operations after implantation are also observer (1.6 vs. 1.3; p ! 0.05) Patients with a higher CVP have a 35% increase chance of dying within the first month of the implantation of the pump (p ! 0.05). There was a decrease of 15% in the rate of re-hospitalizations in patients with lower values of CVP. Higher CVP values were also correlated with higher hepatic enzymatic values. Lower blood pressures and bigger pulmonary wedge pressures are also observed. No significant difference was observed between the results in both pumps. Conclusion: The results of this study clearly show the relation between LVAD outcomes and the value of the CVP on the first days after the pump implantation.
175 The Effect of Continues Force on Myocardium Local Geometric and Dynamics Lea Lak1, Amir Sherman1, Michal Lipperman1, Amit Tubishevits1, Yael BenShabat1, Remo Almog1, Boaz Nishri1; 1CorAssist Cardiovascular, Herzliya, Israel Introduction: Diastolic heart failure (DHF) accounts for 30% to 55% of heart failure cases, resulting in significant mortality and morbidity. Management of DHF is empirical, limited, and disappointing. A new passive mechanical device (the IMCARDIA) was designed to treat DHF, by transferring a mechanical energy from LV systole phase to diastole phase. The supplement energy reduces the work that the blood needs to apply on the LV during the diastole and reduces the pressure. The device is composed of Attachment Screws (AS) which penetrates 1/2 -2/3 of the myocardium, Elastic Elements (EE) which positioned on the external surface of the LV.The EE applies continues force on the myocardium via the AS which its impact is unknown. Our aim is to study the effect of the device force on the myocardium local geometric and dynamics characteristics, and their implications on the device performance. Methods: The device was implanted on the beating heart of twelve healthy sheep for up to 170 days FU. Local epicardial strain and length were calculated using x-ray images processing. The EE applied force was calculated using superposition based analytical model that had been developed. Results: During the first 40 days the device force caused local tissue creeping which led to degradation of the device force. Thereafter, the tissue creeping stopped (Figure 1). In spite of the tissue creeping, the local strain remained unchanged during all FU period and as a result, the energy that the device had transferred into the LV during the diastole phase didn’t decrease (Figure 2). Conclusion: This study demonstrates that a passive mechanical device, which applied constant force on the myocardium, can be safely implanted without performance degradation due to the tissue creeping.
HFSA
S125