Pre-Operative Hemodynamic Guidance by Cardiomems to Improve LVAD Outcome

PURPOSE: LVAD therapy remains a complex treatment, associated with high mortality and morbidity. Optimizing patients shortly before LVAD surgery can improve post-surgery outcomes. Therefore, we aimed to investigate the feasibility of pre-LVAD surgery optimization using the hemodynamic monitoring provided by the CardioMEMS to improve post-LVAD surgery outcome. METHODS: Ten consecutive chronic heart failure patients, with an INTERMACS Class 2-5, scheduled for (semi-) elective LVAD surgery where enrolled in the HEMO-VAD pilot study. The median age was 59.7 [52.4-63.0] years, and 70.0% of patients were men. All patients received before LVAD surgery a CardioMEMS device. The daily hemodynamic readings were used to guide the patient optimization process pre and post-operative. Aims of hemodynamically optimization were normalization of the mean pulmonary artery pressure (mPAP) and decongesting of the right ventricle and optimization of the renal function. In this analysis, we investigated the occurrence of a combined endpoint of all-cause mortality, right-sided HF or renal replacement therapy (RRT) during the first 3 months of follow-up (time to first event analysis). RESULTS: During the optimization period, the mean cumulative reduction of mPAP was larger in the hemodynamic optimized patients (-58.8±82.9mmHg day) compared with those not hemodynamically optimized (0.8±29.3mmHg day). During the first three months post-LVAD surgery, the combined endpoint occurred in four out of six not hemodynamically optimized patient, compared to none off the hemodynamically optimized patients (p=0.05) (Figure). A trend towards better event-free survival of right-sided HF and RRT was observed in hemodynamically optimized patients. CONCLUSION: This pilot study demonstrates the feasibility of hemodynamic guided optimization using the CardioMEMS before LVAD surgery, which identified a group of patients at increased risk of all-cause mortality, right-sided HF, and RRT if not hemodynamically optimized pre-operatively.

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