title: A UK Single Centre Retrospective Analysis of the Relationship between Haemodynamic Changes and Outcome in Patients Undergoing Prolonged Left Ventricular Assist Device Support.
abstract: OBJECTIVE
  Despite their efficacy, LVADs remain associated with serious complications. The relationship between haemodynamic changes during support and outcome remains inadequately characterised. This association was investigated in LVAD recipients undergoing prolonged support.
  
  
  METHODS
  Forty patients receiving LVAD therapy for >2 years were reviewed retrospectively (mean support duration was 38.62 ± 15.28). Pre- and on-LVAD haemodynamic data were assessed in three groups: (1) those receiving ongoing support (n = 24); (2) those who underwent cardiac transplantation (n = 4); (3) those who died during support (n = 12).
  
  
  RESULTS
  For group 1 and 2, LVAD support achieved a decrease in mean PAP, mean PCWP, TPG, and PVR and an increase in thermodilution blood flow (TBF) with significance at ≤5% level. For group 3, there were non-significant changes in TPG and PVR at the 5% level but for mean PAP, mean PCWP, and TBF the changes were similar to Groups 1 and 2 with significance at ≤5% level. Aggregated data from all three groups showed a 58% increase in TBF on LVAD support.
  
  
  CONCLUSIONS
  Highly significant and favourable haemodynamic changes were found. However, group 3 did not undergo decrease in TPG and PVR possibly because of suboptimal LVAD flow, right heart dysfunction and unavoidable prolongation of support.
authors.affiliation: Department of Cardiothoracic Surgery, Transplantation & Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Capoccia
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Bowles
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: Andre
authors.initials: A
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000503:physiopathology; D011652:Pulmonary Circulation; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D016277:Ventricular Function, Left; D055815:Young Adult