engleski

The Change in Pulmonary Vascular Resistance After LVAD Implantation - Can It Aid in Predicting Postimplantation Survival?

Purpose: Choosing the optimal candidates for LVAD implantation is a chal¬lenging task. Different risk models have been proposed and various fac¬tors are associated with a poor outcome. We aimed to analyze the group of patients implanted with an LVAD at our institution in regards to pre- and postoperative factors in relation to survival outcome. Methods: During the past 2 years, 20 pts (18 M, 2 F, mean age 58.7±8.3 y) have been implanted with an LVAD in our institution. Patient history, INTERMACS score, pre- and postimplantation laboratory results, echo and RV catheterization data were collected and compared according to overall survival. The t-test was used to determine the statistical signifi¬cance (set at 0.05). Results: Overall, 11 pts (55%) have died (7 in-hospital mortality, 4 late-mor¬tality). 50% of the overall pts. had an INTERMACS 4 score and the remain¬ing pts were of lower INTERMACS score, while there was no difference in the score between the surviving and expired pts. Of the relevant pre-op parameters, there was no significant difference between the survival groups: RV function was generally slightly decreased (FAC 21±10% vs 30±13%, TAPSE 1, 5±0, 4 cm vs 1.3±0.5 cm, alive vs expired, NS), the cardiac index was low (1.7±0.5 L/min/m2 vs 1.8±0.5 L/min/m2, alive vs expired, NS), TPG values were borderline (13±5.3 mmHg vs 12.6±8.3 mmHg, alive vs expired, NS) and PVR was moderately elevated (3.7±1.4 WU vs 3.2±2.6 WU, alive vs expired, NS). Preoperative data significantly differed only in the platelet count being lower in the expired pts (250±64x103/mm3 vs. 154±65x103/mm3, p< 0.01). Significantly higher post-implant PVR was found in the expired compared to the living pts (3.8±2.8 WU vs. 1.8±0.4 WU, p< 0.05). Notably, all of the expired pts had a significant increase in postoperative PVR values (0.59±0.25 WU), while it was decreased in all but one of the surviving pts (2.02±1.74 WU, p= 0.02). Conclusion: These preliminary data show that there is no significant dif¬ference in predictors of survival among our patients with a generally low INTERMACS score, apart from a low platelet count. However, there is a clear increase in postoperative PVR values in the expired pts, which warrants further investigation.

Pulmonary Vascular Resistance; LVAD; Postimplantation Survival

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