P997Differences in early postoperative intracardiac hemodynamics in patients with implantable LVAD or biVAD system


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Abstract

VAD implantation became more suffered technology in patients who are listed for a heart transplant. Nevertheless it is a non-resolved practical approach which type of VAD more useful in patients with end-stage heart failure because of different impact to circulation and follow-up and also because of patients with severe left ventricular dysfunction had subclinical signs of right ventricular impairment.The estimation of hemodynamical data and its changing early after LVAD/biVAD implantation in patients with end-stage heart failure due to dilated or ischemic cardiomyopathy was aimed in the study.From 2008 year fourteen patients (accordingly European Recommendation 2008) were undergone surgery with implantable LVAD (10 pts) or biVAD (4 pts) implantation. Patients with isolated RVAD system were excluded from study. Before surgery all patients had significantly depressed LV pump function (LVEF 16.1±4.0%, SVI 26.3±10.1 ml/m2), dilated LV (EDD 77.4±10.6 mm, ESD 69.9±11.3 mm, EDVI 166.0±55.5 ml/m2, ESVI 139.7±48.3 ml/m2), dilated RV (short axis 47.9±7.2 mm, long axis 85.5±8.9 mm, inflow part diastolic and systolic volume 111.3±38.5 ml and 80.7±33.4 ml resp.) with depression of systolic function (RVEF 28.9±7.5%). Groups (LVAD and biVAD) were similar in LV size and function, LA size, RA size, RV function (RVEF LVAD 30.4±7.3% and biVAD 25.3±7.1%, p=0.14), but patients with biVAD had 1.5 fold larger right ventricle vs patients with LVAD (for RV EDV p= 0.0036, RV ESV p=0.004). Early after operation patients of group LVAD with basally more severe LV hypertrophy (p=0.006) had slight but insignificant decreasing of left and right ventricular volumes (EDD p=0.06 and EDV p= 0.076), but improvement of RV function (RVEF p=0.011). Patients of group biVAD is characterized dramatic improvement of left ventricle pump function (LVEF p=0.005) with its volumes decreasing (EDV p=0.004, ESV p=0.013). Systolic PAP was similar before and after surgery in both group via Stevensons equation, but was different via tricuspid valve regurgitation velocity (LVAD 57.4±7.2 mm Hg and biVAD 40.5±3.7 mm Hg, p<0.0001) and felt significantly early after surgery in group LVAD only (p=0.002).Conclusion: patients with different type of VAD had different dynamics of intracardiac parameters. LVAD implantation leads more significant right ventricle improvement, and biVAD implantation - LV improvement with decreasing of RV volumes. Systolic PAP dynamics could be nevilated the poor RV systolic function. These short-term results must be investigate in larger cohort of patients with more detailed analysis of invasive cardiac and pulmonic parameters.

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