Validation of non-invasive ramp testing for HeartMate 3

Area of Science:

• Cardiology
• Medical Devices
• Echocardiography

Background:

• Left ventricular assist devices (LVADs) are crucial for managing advanced heart failure.
• Optimizing LVAD speed is essential for effective left ventricular (LV) unloading and patient outcomes.
• Postoperative ramp testing can be utilized to fine-tune LVAD performance.

Purpose of the Study:

• To evaluate if a non-invasive echocardiographic ramp test improves LV unloading after HeartMate 3 implantation.
• To assess if LVAD speed adjustments during ramp testing negatively affect right ventricular (RV) function.

Main Methods:

• Retrospective review of 14 clinically stable patients who underwent echocardiographic ramp testing post-LVAD implantation.
• LV unloading assessed by mitral regurgitation, aortic valve status, LV end-diastolic diameter, and NT-proBNP levels.
• RV function monitored during and after ramp testing and final LVAD speed adjustments.

Main Results:

• Ramp testing led to LVAD speed increases in 79% of patients, with a median increase of 200 rpm.
• Improved LV unloading was achieved in 21% of patients not initially optimized.
• No significant worsening of RV function was observed during or after ramp testing.

Conclusions:

• Echocardiography-guided ramp testing is effective for optimizing LVAD speed and enhancing LV unloading.
• The ramp test procedure does not compromise RV function.
• This non-invasive approach aids in achieving optimal LVAD performance in the postoperative period.