The prognostic nutritional index (PNI) is a simple metric that uses serum albumin and total lymphocyte count to provide a basic indicator for nutritional status. It has recently garnered attention as a prognosticator of outcomes in many types of cancer. We investigated the utility of the PNI as a marker for poor outcomes following left ventricular assist device (LVAD) implantation. Two hundred eighty-eight consecutive patients implanted with continuous-flow LVADs were included. Prognostic nutritional index was calculated for all patients (PNI = [10 × serum albumin {g/dl}] + [0.005 × total lymphocytes {1,000/μl}]). The population was split into two groups based on median PNI; group 1 with PNI <30 and group 2 with PNI ≥30. Mean age was 60.3 years in group 1 and 59.8 years in group 2. There were no significant differences between groups in terms of age, gender, ethnicity, or comorbidities. The mean PNI for the group as a whole was 30.1 ± 4.6, indicating pervasive malnutrition in this group of advanced heart failure patients. Group 1 had significantly longer postoperative length of stay than did group 2 (27.42 ± 19.31 vs. 21.66 ± 15.0 days; p = 0.008). Patients in group 1 also had higher rates of right ventricular failure (37.8% vs. 25.5%; p = 0.025). A multivariate model indicated that PNI less than 30 was associated with a 12.2% reduction in postoperative survival (Hazard Ratio: 0.888; confidence interval [CI]: 0.795-0.993; p = 0.037). Our results suggest that the PNI may be an indicator for worsened outcomes in patients with advanced heart failure. These patients, who often suffer from chronic malnutrition, may experience worsened outcomes because of associated neurohormonal, muscular, and metabolic derangements.

This study assessed the use of the MoCA in patients with end-stage HF being evaluated for advanced surgical therapy. We found the MoCA to be a rapid, simple, and powerful tool for detecting cognitive impairment in these patients. MCI was highly prevalent in the cohort. Significant improvement in overall MoCA score was noted after LVAD implantation.

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Handgrip strength measurement at the bedside is a simple and effective means of assessing functional status and risk for increased LOS following LVAD implantation, which may aid in preoperative evaluation of LVAD candidacy.

The use of left ventricular assist devices (LVADs), implantable pumps used to supplement cardiac output, has become an increasingly common and effective treatment for advanced heart failure. Although modern continuous-flow LVADs improve quality of life and survival more than medical management of heart failure, device malfunction remains a common concern. Improved noninvasive methods for assessment of LVAD function are needed to detect device complications. An electronic stethoscope was used to record sounds from the HeartMate II axial flow pump in vitro and in vivo. The data were then uploaded to a computer and analyzed using two types of acoustic analysis software. Left ventricular assist device acoustics were quantified and were related to pump speed, acoustic environment, and inflow and outflow graft patency. Peak frequency values measured in vivo were found to correlate strongly with both predicted values and in vitro measurements (r > 0.999). Plots of the area under the acoustic spectrum curve, obtained by integrating over 50 Hz increments, showed strong correlations between in vivo and in vitro measurements (r > 0.966). Device thrombosis was found to be associated with reduced LVAD acoustic amplitude in two patients who underwent surgical device exchange. ASAIO Journal 2016; 62:46-55.