Cardiac remodeling in patients with centrifugal left ventricular assist devices assessed by serial echocardiography
Johanna Mulzer1, Hristo Krastev1, Christoph Hoermandinger2
1German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.
Insights
Centrifugal left ventricular assist device (cfLVAD) therapy improves left ventricular remodeling and reduces mitral and tricuspid regurgitation. However, right ventricular function remains unchanged, and aortic regurgitation increases over time.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- Left ventricular assist devices (LVADs) are crucial for managing advanced heart failure.
- Understanding the long-term cardiac remodeling effects of LVADs is essential for patient management and device selection.
Purpose of the Study:
- To characterize the cardiac remodeling process in patients supported by centrifugal left ventricular assist devices (cfLVADs) using serial echocardiography.
- To assess changes in left and right ventricular function, valvular regurgitation, and the potential for device explantation.
Main Methods:
- A retrospective review of 512 standardized transthoracic echocardiograms from 3/2018 onwards (preoperative, 6 months, and 12 months post-implantation).
- Analysis included left ventricular diameter, ejection fraction, fractional area change, tricuspid annular excursion, right ventricular fractional area change, and valvular regurgitation (mitral, tricuspid, aortic).
Main Results:
- Significant reduction in left ventricular diameter and improvement in left ventricular ejection fraction and fractional area change were observed.
- Improvement in mitral and tricuspid regurgitation noted; however, right ventricular function did not improve.
- Potential for cfLVAD explantation increased over time, with aortic valve opening seen in most patients. Moderate aortic regurgitation prevalence increased with support duration.
Conclusions:
- LVAD therapy promotes reverse left ventricular remodeling and improves mitral and tricuspid regurgitation.
- Right ventricular function does not improve, and the incidence of aortic regurgitation increases with mechanical support duration.
- No significant echocardiographic differences were found between HeartWare HVAD™ and HeartMate 3™ devices.
Aim:
The aim of the study was to characterize the remodeling process in a large cohort of patients supported with a centrifugal left ventricular assist device (cfLVAD) by standardized serial echocardiography.
Methods And Results:
From 3/2018 all cfLVAD patients underwent transthoracic echocardiography at 6 and 12 months after implantation using a standardized protocol. A total of 512 echocardiograms were reviewed (216 preoperative, 156 at 6 months, 140 at 12 months). While on cfLVAD support, left ventricular (LV) diameter decreased (p < .001). LV ejection fraction (LVEF) and LV fractional area change improved (p < .001). Potential for cfLVAD explantation (as defined by an LVEF ≥45% and opening of the aortic valve [AV]) was seen in nine patients at 6 and 21 patients at 12 months. The tricuspid annular excursion decreased significantly, while the right ventricular fractional area change did not change. Tricuspid regurgitation (TR) and mitral regurgitation (MR) improved significantly during LVAD support. Opening of the AV was seen in >64% of the patients at 6 months and in 66% at 12 months. Moderate aortic regurgitation (AR) was rare with 3.8% at 6 months but increased with the duration of cfLVAD support (8.5% at 12 months). We found no significant difference in echocardiographic parameters between patients supported with a HeartWare HVAD™ or a HeartMate 3™ device.
Conclusion:
LVAD therapy can lead to reverse LV remodeling and improvement of MR and TR. However, right ventricular function does not improve and prevalence of AR progressively increases during mechanical support.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Cardiomyopathy II: Dilated Cardiomyopathy