title: Normalisation of haemodynamics in patients with end-stage heart failure with continuous-flow left ventricular assist device therapy.
abstract: BACKGROUND
  New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF).
  
  
  METHODS
  We reviewed 53 consecutive patients (mean age 49.5 ± 14.1 yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n=35) and echocardiography (n=39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support.
  
  
  RESULTS
  A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p<0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4mm (p<0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8 mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 μmol/L (p<0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n=18) compared to those without (96.9%, n=35, p=0.01).
  
  
  CONCLUSIONS
  HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term.
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia.
authors: Sunil
authors: S
authors: Gupta
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia.
authors: Kei
authors: K
authors: Woldendorp
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Faculty of Medicine, Victor Chang Cardiac Research Institute, Sydney, Australia.
authors: Kavitha
authors: K
authors: Muthiah
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
authors: Desiree
authors: D
authors: Robson
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
authors: Roslyn
authors: R
authors: Prichard
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Faculty of Medicine, Victor Chang Cardiac Research Institute, Sydney, Australia.
authors: Peter S
authors: PS
authors: Macdonald
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Faculty of Medicine, Victor Chang Cardiac Research Institute, Sydney, Australia.
authors: Anne M
authors: AM
authors: Keogh
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
authors: Eugene
authors: E
authors: Kotlyar
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, Victor Chang Cardiac Research Institute, Sydney, Australia.
authors: Andrew
authors: A
authors: Jabbour
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia.
authors: Kumud
authors: K
authors: Dhital
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
authors: Emily
authors: E
authors: Granger
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
authors: Phillip
authors: P
authors: Spratt
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
authors: Paul
authors: P
authors: Jansz
authors: Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Faculty of Medicine, Victor Chang Cardiac Research Institute, Sydney, Australia. Electronic address: cshayward@stvincents.com.au.
authors: Christopher S
authors: CS
authors: Hayward
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D012964:Sodium / Q000097:blood; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology
chemical_list: D012964:Sodium; D003404:Creatinine
keywords: Clinical outcomes; Haemodynamics; Heart failure; Heart-assist devices; Left ventricular function; Pulmonary hypertension