Maximum Vasoactive Inotropic Score in the 48 Hours Post-LVAD Implantation Predicts 90 Day Mortality

S172 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 Table 1. Baseline Data for Responders and Non-Responders for Change in RV and LVEDV

Age (yr) Male (%) Atrial fibrillation (%) Ischemic (%) Ejection Fraction (%) LVEDV (mL) Regurgitant Volume (mL)

Regurgitant Volume Nonrespondersn=27

Regurgitant Volume

LVEDV Nonrespondersn=25

LVEDV

Respondersn=27

66.7 §11.1 85.2 (23/27) 55.6 (15/27) 74.1 (20/27) 33.0 § 9.3(n=26) 199.3 § 43.7(n=24) 34.9§ 18.9(n=270

65.7 §13.5 70.4 (19/27) 40.7 (11/27) 59.3 (16/27) 29.4 § 8.7(n=25) 198.1 § 70.6(n=24) 37.2 § 16.1(n=27)

69.7 §9.2 68.0 (17/25) 44.0 (11/25) 80.0 (20/25) 33.4§ 6.8(n=25) *164.5 § 41.6(n=25) 32.1 § 15.4(n=24)

64.3 §13.7 84.0 (21/25) 52.0 (13/25) 52.0 (13/25) 29.5§ 10.2(n=25) *217.7 § 73.4(n=25) 38.6 § 19.7(n=23)

Respondersn=25

471 Acute Cellular Rejection Early after Heart Transplantation Does Not Reduce Exercise Capacity in the First Year Thomas C. Hanff, Robert S. Zhang, Yuhui Zhang, Maria Molina, Rhondalyn C. McLean, Jeremy A. Mazurek, Monique Tanna, Jesus E. Rame, Joyce W. Wald, Pavan Atluri, Michael A. Acker, Lee R. Goldberg, Edo Y. Birati; University of Pennsylvania, Philadelphia, PA Background: Early graft dysfunction after orthotopic heart transplantation is associated with worse survival and functional outcomes. However, the prognostic implication of acute cellular rejection (ACR) early after transplant is less well defined. Here, we analyzed the association between early ACR and posttransplant exercise capacity. Methods: We performed a retrospective analysis of all heart transplant patients who underwent cardiopulmonary exercise testing (CPET) within a year of transplant at a single large academic center between 2000 and 2011. Early ACR was defined as cellular grade 2R or 3R histopathology seen on biopsy within 3 months of transplant. Exercise capacity was assessed during CPET by 1) peak VO2 and 2) total exercise time. CPET performed prior to diagnosis of rejection were excluded. The association between early ACR or grade of ACR and exercise parameters was analyzed using linear regression. Results: A total of 230 patients (median age 55 [IQR 45-61], 79.6% male) who received a heart transplantation at our institution between 2000 and 2011 underwent CPET during the 1st year. Of these, 12% (n=40) developed early grade 2R rejection and 5% (n=12) developed early grade 3R rejection. No antibody mediated rejection (including hyperacute) was seen in this timeframe among patients who later underwent CPET. Neither peak VO2 (p=0.95) nor total exercise time (p=0.54) were predicted by early ACR of any grade. Conclusions: Early cellular rejection does not predict worse exercise capacity in the first year after heart transplant. This inference is limited to patients who are able to undergo CPET.

Bresticker2, Patroklos Pappas2, Antone Tatooles2, William Cotts2, Ambar Andrade2; 1 UIC/Advocate Christ Medical Center, Oak Lawn, IL; 2Advocate Christ Medical Center, Oak Lawn, IL Introduction: Patients with end stage HF not responsive to GDMT are often referred for OHT. IABP are often utilized to support these patients as a bridge. Frailty has been shown to correlate with increased morbidity in such patients. Gait speed is well described in the frailty phenotype in patients with HF. We postulate that interventions to prevent or treat frailty may result in better outcomes after OHT. To that end, our center has an aggressive physical and occupational therapy program in place to assist patients with ambulation and improvement in gait speed prior to surgery. To date, no published literature describes the efficacy of ambulation in patients with femoral IABP. We review the feasibility of ambulation on femoral IABP for patients who eventually underwent OHT at our center. Methods: A retrospective analysis was performed from January 2018-March 2019, which identified four patients with advanced HF who ambulated with femoral IABP prior to OHT. A KREG catalyst standing bed was utilized to advance patients (with femoral IABP) from supine immobility to in-bed tilting, standing, and finally, ambulating off the bed and into the environment with a rolling walker. The first patient was a 26 year old male with HOCM who presented in acute cardiogenic shock. He was optimized with inotropes and had a femoral IABP in place for 128 days prior to OHT. The patient progressed from standing to ambulating, and his preoperative gait speed improved from 0.23 to 1.21 m/s. He had one episode of minor bleed at the site of IABP which resolved with localized pressure. No other complications occurred. The second patient was a 58 year old male with dilated cardiomyopathy on inotropes. He had a femoral IABP for 21 days prior to OHT. He progressed from in-bed standing to ambulating, reaching a preoperative gait speed of 0.46 m/s. No complications occurred. The third patient was a 59 year old male with ICM on inotropes and high-dose diuretics. He had a femoral IABP for 43 days and improved his gait speed from 0.56 to 1.43 m/s. His IABP was displaced once, requiring a device exchange, but no other complications occurred. The fourth patient was a 38 year old male with restrictive cardiomyopathy on inotropic support. He was supported by a femoral IABP for 9 days prior to OHT and progressed from in-bed standing to ambulating, reaching a preoperative gait speed of 0.46 m/s. No complications occurred. All patients did well post-transplant. Average post-operative length of stay was 31 days. All patients walked more than 1000 feet prior to discharge. Conclusions: From our small sample size of four patients ambulating with femoral IABP who eventually underwent OHT, we believe ambulation of such patients is safe and feasible. A larger sample size is needed to establish which patients are safe for ambulation with a femoral IABP and if this method can improve patient outcomes.

473 Maximum Vasoactive Inotropic Score in the 48 Hours Post-LVAD Implantation Predicts 90 Day Mortality Mohammad Hashim Mustehsan, Nitish Gupta, Thiru Chinnadurai, Syed Muhammad Ibrahim Rashid, Salil Kumar, Afsana Rahman, Omar Saeed, Snehal R. Patel, Sandhya Murthy, Jooyoung J. Shin, Stephen Forest, Sasha Vukelic, Daniel J. Goldstein, Ulrich P. Jorde, Daniel B. Sims; Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY Introduction: The vasoactive inotropic score (VIS) is an emerging method to estimate total inotropic and vasopressor support after cardiothoracic surgery. Whether the post-operative VIS score can predict mortality in patients following LVAD implantation is unknown. Methods: We performed a single-center retrospective study of 268 patients who received a continuous-flow durable LVAD between Jan 1, 2006 and Dec 31, 2017. The VIS score was calculated as: dobutamine (mcg/kg/min) + 10 x milrinone (mcg/kg/min) + dopamine (mcg/kg/ min) + 100 x epinephrine (mcg/kg/min) + 100 x norepinephrine (mcg/kg/ min) + 10,000 x vasopressin (units/kg/min). The VIS score at 6, 24, and 48 hours postoperatively were abstracted and then the maximum VIS score within 48 hours after implantation for each patient was used to stratify the cohort into quartiles. Kaplan-Meier method was used to estimate 90-day survival and Cox Hazard model was performed to evaluate for predictors of 90-day mortality. Results: The VIS quartiles groups were 0-9, 10-16, 17-23, and 24-87. Patients in quartile 4 were older and had a higher preoperative right atrial pressure (Table 1). VIS quartiles demonstrate a stepwise increase in adjusted hazard ratio compared to the 1st quartile in our multivariable model (which included age, total bilirubin over 2.5, gender, and VIS) with VIS quartile 2 HR 2.45 (95% CI 0.65 - 9.24, p = 0.18), VIS quartile 3 HR 3.39 (95% CI 0.90 - 12.79, p = 0.07), VIS quartile 4 HR 4.53 (95% CI 1.28 - 16.05, p = 0.02). Figure 1 demonstrates worsened survival by VIS quartiles up to 90-days post LVAD implantation (logrank test p=0.048). Conclusion: Elevated VIS score within the first 48 hours after LVAD implantation correlates with an increased risk of mortality at 90 days. Further work is needed to confirm this relationship.

472 Ambulating Patients with Femoral Intra-Aortic Balloon Pump as Bridge to Heart Transplant - A Case Series Sheraz Hussain1, Chad Morreale1, Meghan Gushurst2, Anjali Joshi2, Christopher Sciamanna2, Gregory Macaluso2, Sunil Pauwaa2, Muhyaldeen Dia2, Michael