Why should we perform hemodynamic ramp test following left ventricular assist device implantation?
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 3
Abstract
Left ventricular assist device (LVAD) is a strong therapeutic tool to improve survival in patients with advanced heart failure, whereas not a few patients have potentially abnormal hemodynamics despite LVAD supports. Hemodynamic ramp test, which is recently proposed to undergo following LVAD implantation, is a promising procedure to predict patient clinical outcome by assessing hemodynamic profile and to improve patients’ prognosis by optimizing hemodynamics via LVAD speed adjustment. Further prospective randomized control trial is warranted to clearly demonstrate clinical implication of the ramp test.Owing to the improvement of device technology, more sophisticated management protocol, and cumulating clinical knowledge, actual survival for the patients with advanced heart failure (HF) receiving left ventricular assist device (LVAD) improved dramatically during the recent several decades (Figure 1) [1]. Nevertheless, the rates of re-admission due to device-related comorbidities remain high and unsolved issues thus far [2]. LVAD theoretically normalizes patients’ hemodynamics by reducing left ventricular loading and supporting cardiac forward flow. However, our team recently showed that almost half of patients had abnormal hemodynamics following LVAD implantation, despite they were clinically stable outpatients [3]. Optimization of hemodynamics may be a key for overcoming various comorbidities during LVAD support. For the purpose of this, hemodynamic ramp test, which our team recently proposed [3], may be useful for the assessment of hemodynamics and improving clinical outcomes.Our team recently proposed a utility of hemodynamic ramp test [3], during which a complete set of hemodynamic parameters is invasively measured by right heart catheterization at each LVAD speed and the LVAD speed is finally adjusted considering the primary goal of central venous pressure (CVP) <12 mmHg, pulmonary capillary wedge pressure (PCWP) <18 mmHg, and cardiac index (CI) >2.2 L/min/m2 and the secondary goal of intermittent opening of aortic valve, minimizing mitral valve regurgitation, and appropriate positioning of interventricular septum (Figure 2) AB is an example of the results, in which CVP and PCWP improve in many patients by LVAD speed adjustment.
Authors and Affiliations
Teruhiko Imamura
Keywords
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- EP ID EP591772
- DOI 10.26717/BJSTR.2018.09.001813
- Views 163
- Downloads 0
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