Introduction: Myocardial recovery occurs in small cohort of patients receiving left ventricular assist device (LVAD) support, but identification of candidates for device removal remains challenging.
Hypothesis: We hypothesized that hemodynamic evaluation during LVAD speed ramp and volume loading test can assess cardiac recovery to predict successful device removal.
Methods: The LVAD pump speed was decreased in 4 stages from the patient’s optimal speed to the minimal setting of the device. Under the minimal LVAD support, saline loading (body weight x 10mL in 15 minutes) was done. Echocardiographic and right heart catheter data were obtained in each stage of the LVAD ramp test, and every 3 minutes during the saline loading test. A total of 31 patients (HeartMate II 12, DuraHeart 7, Jarvik2000 5, EVAHEART 5, HVAD 2) underwent the test at our institution. The patients were divided into 2 groups: those who underwent successful LVAD explantation (Group R, n = 6) and those who did not (Group N, n = 25). Echocardiographic and hemodynamic response to the LVAD ramp and saline loading was compared between the groups using repeated analysis of valiance.
Results: During the test, arterial pulse pressure increased significantly in the both groups (time effect p < 0.0001) and the pulse pressure was significantly higher in group R than in group N (group effect p = 0.0047). Pulmonary capillary wedge pressure increased significantly during the test (time effect p < 0.0001) and the increase was significantly larger in group N than in group R (Figure 1, group effect p = 0.0323, interaction effect p = 0.0053). Cardiac output tended to be higher in group R than in group N (group effect p = 0.08). All the 6 patients who were removed of LVAD are free from recurrence of heart failure for 36 ± 20 months.
Conclusions: LVAD ramp and volume loading test facilitates the precise evaluation of the native heart function during the continuous-flow LVAD support and predicts the successful weaning from the device support.