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Longitudinal analysis of pump parameters over long-term support with the HeartMate 3 left ventricular assist device
Filippo Consolo1, Marina Pieri1,2, Vittorio Pazzanese3
1Università Vita Salute San Raffaele, Milano.
Insights
HeartMate 3 left ventricular assist device (LVAD) support requires increasing pump settings over time, indicating worsening heart function. This progression may explain heart failure mortality in LVAD patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Heart failure remains a leading cause of mortality in patients with left ventricular assist devices (LVADs).
- The HeartMate 3 (HM3) LVAD is a common device used to support patients with advanced heart failure.
- Understanding the long-term effects of HM3 device parameters on cardiac function is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the longitudinal changes in HM3 pump parameters over extended support periods.
- To explore the relationship between these parameter changes and left ventricular mechanics.
- To derive a mechanistic rationale for long-term mortality causes in HM3 patients.
Main Methods:
- Prospective data collection of pump parameters (speed, flow, pulsatility index) in HM3 patients.
- Data recorded at baseline, 6, 12, 24, 36, 48, and 60 months post-implantation.
- Analysis of 43 consecutive patients with regular clinical and echocardiographic assessments.
Main Results:
- A significant progressive increase in HM3 pump speed was observed over 60 months of support (P = 0.0007).
- Correspondingly, pump flow significantly increased (P = 0.007), while pulsatility index significantly decreased (P = 0.005).
- These changes suggest a potential decline in left ventricular function over time.
Conclusions:
- The observed increase in HM3 pump support indicates a potential lack of left ventricular recovery and worsening function.
- This worsening ventricular function may be a mechanistic driver of heart failure-related mortality in HM3 patients.
- Optimizing HM3 pump algorithms is necessary to enhance LVAD-LV interaction and improve long-term clinical outcomes.
Aims:
Recurrence of heart failure emerged as the main cause of long-term mortality in patients implanted with the HeartMate 3 (HM3) left ventricular assist device (LVAD). We aimed at deriving a possible mechanistic rationale of clinical outcomes and analyzed longitudinal changes in pump parameters over prolonged HM3 support to investigate long-term effects of pump settings on left ventricular mechanics.
Methods:
Data on pump parameters (i.e. pump speed, estimated flow, and pulsatility index) were prospectively recorded in consecutive HM3 patients following postoperative rehabilitation (baseline) and then at 6, 12, 24, 36, 48, and 60 months of support.
Results:
Data of 43 consecutive patients were analyzed. Pump parameters were set according to regular patients' follow-up, including clinical and echocardiographic assessment. We recorded a significant progressive increase in pump speed over the course of support: from 5200 (5050-5300) rpm at baseline to 5400 (5300-5600) rpm at 60 months of support ( P = 0.0007). Consistently with the increase in pump speed, a significant increase in pump flow ( P = 0.007) and a decrease in pulsatility index ( P = 0.005) were also recorded.
Conclusion:
Our results reveal unique features of the HM3 on left ventricular activity. The need for progressive increase in pump support suggests indeed a lack of recovery and worsening of left ventricular function, which emerge as a possible mechanistic rationale of heart failure related mortality in HM3 patients. New algorithms to optimize pump settings should be envisioned to further improve LVAD-LV interaction and, ultimately, clinical outcomes in the HM3 population.
Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT03255928.
Clinicaltrialsgov Identifier:
NCT03255928.
