Anemia after Continuous-flow Left Ventricular Assist Device Implantation: Characteristics and Implications

Amione‐Guerra, Javier; Cruz-Solbes, A.S.; Bhimaraj, Arvind; Trachtenberg, Barry; Pingali, Sai Ravi; Estep, Jerry D.; Park, Myung H.; Guha, Ashrith

doi:10.5301/ijao.5000607

Cited by 18 publications

(20 citation statements)

References 28 publications

(35 reference statements)

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“…[ 71 – 73 ] However, it could be speculated that weight gain (as seen in Schmidt et al[ 45 ]) could affect specific AEs; in particular, large body size and associated comorbidities, such as diabetes, may leave the patient more prone to infection, thereby lowering FC, as discussed above. [ 74 ]…”

Section: Resultsmentioning

confidence: 99%

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Mirza

Gustafsson

2020

Card Fail Rev

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Continuous-flow left ventricular assist devices (LVAD) are increasingly used as destination therapy in patients with end-stage heart failure and, with recent improvements in pump design, adverse event rates are decreasing. Implanted patients experience improved survival, quality of life (QoL) and functional capacity (FC). However, improvement in FC and QoL after implantation is not unequivocal, and this has implications for patient selection and preimplantation discussions with patients and relatives. This article identifies preimplantation predictors of lack of improvement in FC and QoL after continuous-flow LVAD implantation and discusses potential mechanisms, allowing for the identification of potential factors that can be modified. In particular, the pathophysiology behind insufficient improvement in peak oxygen uptake is discussed. Data are included from 40 studies, resulting in analysis of >700 exercise tests. Mean peak oxygen uptake was 13.4 ml/kg/min (equivalent to 48% of predicted value; 259 days after implantation, range 31–1,017 days) and mean 6-minute walk test distance was 370 m (182 days after implantation, range 43–543 days). Finally, the interplay between improvement in FC and QoL is discussed.

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Section: Resultsmentioning

confidence: 99%

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Mirza

Gustafsson

2020

Card Fail Rev

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“…The reason why anemia relates to exercise capacity can be introduced by Fick formula; that is, decreased arterial oxygen content by anemia impairs oxygen delivery during exercise. Many patients with LVAD complicate anemia and have a relatively high frequency of iron deficiency, 31 and erythrocyte trauma, or hemolysis. 32 Thus, treatment and prevention of anemia against iron deficiency and hemolysis should be attempted.…”

Section: Discussionmentioning

confidence: 99%

Associations between hemodynamic parameters at rest and exercise capacity in patients with implantable left ventricular assist devices

et al. 2020

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Background: Hemodynamic parameters at rest are known to correlate poorly with peak oxygen uptake (VO2) in heart failure. However, we hypothesized that hemodynamic parameters at rest could predict exercise capacity in patients with left ventricular assist device (LVAD), because LVAD pump rotational speed does not respond during exercise. Therefore, we investigated the relationships between hemodynamic parameters at rest (measured with right heart catheterization) and exercise capacity (measured with cardiopulmonary exercise testing) in patients with implantable LVAD. Methods: We performed a retrospective medical record review of patients who received implantable LVAD at our institution from November 2013 to December 2017. Results: A total of 20 patients were enrolled in this study (15 males; mean age, 45.8 years; median duration of LVAD support, 356 days). The mean peak VO2 and cardiac index (CI) were 13.5 mL/kg/min and 2.6 L/min/m2, respectively. CI and hemoglobin level were significantly associated with peak VO2 (CI: r = 0.632, p = 0.003; hemoglobin: r = 0.520, p = 0.019). In addition, pulmonary capillary wedge pressure, right atrial pressure, and right ventricular stroke work index were also significantly associated with peak VO2. In multiple linear regression analysis, CI and hemoglobin level remained independent predictors of peak VO2 (CI: β = 0.559, p = 0.006; hemoglobin: β = 0.414, p = 0.049). Conclusions: CI at rest and hemoglobin level are associated with poor exercise capacity in patients with LVAD.

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“…Those without iron deficiency demonstrated laboratory measurements consistent with anemia of chronic disease. In this limited series, those with anemia had a worse New York Heart Association classification at 6 months and had a higher rate of hospital readmission for HF (11% vs. 30%, p = 0.01) 68 . Researchers also found iron deficiency anemia in 62% (n = 67) of durable LVAD recipients.…”

Section: Chronic Outpatient Managementmentioning

confidence: 74%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

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Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure, yet still require concomitant medications in order to achieve the best possible clinical outcomes. Since the outset of routine placement of durable, continuous‐flow LVADs, much of the medication management of these patients to date has been based on International Society of Heart and Lung Transplantation (ISHLT) guidance, most recently published in 2013. Since 2013, numerous multidisciplinary pharmacotherapy publications have increased the LVAD community's understanding of best practices with respect to medications. We identified the major domains of LVAD medication management and conducted a comprehensive search of US National Library of Medicine MEDLINE® database using keywords chosen to identify medication‐related publications of significance dated 2013 or later. Trials pertaining to the HeartMate II™ and the HeartMate™ 3 LVADs (Abbott, Chicago, IL) and the HeartWare™ HVAD™ System (Medtronic, Minneapolis, MN) were chosen for inclusion. Highest priority for inclusion was given to prospective, randomized, controlled studies. Absent these, controlled trials (retrospective or prospective observational) were given next‐highest consideration, followed by retrospective uncontrolled studies, and finally case series. Reference lists of qualified publications were reviewed to find any other publications of interest that were not discovered on initial search. Case reports were generally excluded, except where the insight gained was deemed to be uniquely pertinent. This document serves to provide a comprehensive review of the current understanding of optimal medication management in patients with durable, continuous‐flow LVADs.

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Anemia after Continuous-flow Left Ventricular Assist Device Implantation: Characteristics and Implications

Abstract: The most common cause of anemia in our study was iron-deficiency; almost half of the patients were iron deficient despite treatment, suggesting that oral iron may not be sufficient to reverse anemia. Anemia regardless of etiology was associated with adverse outcomes.

Cited by 18 publications

References 28 publications

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device

Associations between hemodynamic parameters at rest and exercise capacity in patients with implantable left ventricular assist devices

Pharmacotherapy for durable left ventricular assist devices

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