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Echo-guided LVAD speed optimization for exercise maximization
Abstract Background Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the a...
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| Published in: | European heart journal 2021-10, Vol.42 (Supplement_1) |
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| Main Authors: | , , , , , , , , |
| Format: | Article |
| Language: | English |
| Online Access: | Get full text |
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| Summary: | Abstract
Background
Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the automatic speed adjustment capability. However, it was shown that acceleration of the pump speed during stress test increases the maximum exercise tolerance.
Purpose
The study aimed to evaluate the concept of dynamic pump speed optimization based on the echocardiographic assessment of aortic valve opening (AVO) during the cardiopulmonary exercise test (CPET).
Methods
Patients with implanted third-generation centrifugal continuous-flow LVAD's with hydrodynamic bearing were prospectively included. Two CPET's were performed after resting speed optimization. The first one with maintained baseline pump speed settings, and the second one with gradually increased speed depending on live echocardiographic imaging. The sequence of tests was random.
Results
Exercise AVO was apparent in all 22 included patients. The resting pump speed was 2691 RPM and incremented on average by 566 RPM (20%). Pump power and flow raised from 5.6 to 9.8 Watts (p |
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| ISSN: | 0195-668X 1522-9645 |
| DOI: | 10.1093/eurheartj/ehab724.0947 |