Blood Pressure and Adverse Events During Continuous Flow Left Ventricular Assist Device Support

Saeed, Omar; Jermyn, Rita; Kargoli, Faraj; Madan, Shivank; Mannem, Santhosh; Gunda, Sampath; Nucci, C.; Farooqui, Sarah; Hassan, Syed Adeel; McLarty, Allison; Bloom, Michelle E.; Zolty, Ronald; Shin, Julia; D’Alessandro, David A.; Goldstein, Daniel J.; Patel, Snehal R.

doi:10.1161/circheartfailure.114.002000

Cited by 70 publications

(51 citation statements)

References 13 publications

(11 reference statements)

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“…In addition, similar to previous studies , we suspected that the “MAP” measured by Doppler and pulse oximeter is closer to the systolic arterial pressure (SAP) rather than the MAP when flow approaches pulsatile physiology. When patients were divided according to aortic valve opening (all of the time compared to none or every 2–3 beats), we indeed found that the resulting “MAP” according to Doppler and pulse oximeter correlated with the SAP ( r = 0.90 for Doppler and r = 0.91 for pulse oximeter) in patients with the aortic valve opening every beat.…”

Section: Resultssupporting

confidence: 84%

“…Therefore, an important consideration in the noninvasive assessment of BP in an individual LVAD patient is the degree of aortic valve opening on the last echocardiogram. Despite this limitation, in a large study of Doppler derived BP in LVAD patients, a value of 90 mm Hg was associated with adverse events regardless whether this value reflected MAP or SAP .…”

Section: Discussionmentioning

confidence: 99%

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Pulse Oximeter Derived Blood Pressure Measurement in Patients With a Continuous Flow Left Ventricular Assist Device

et al. 2016

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Currently, blood pressure (BP) measurement is obtained noninvasively in patients with continuous flow left ventricular assist device (LVAD) by placing a Doppler probe over the brachial or radial artery with inflation and deflation of a manual BP cuff. We hypothesized that replacing the Doppler probe with a finger-based pulse oximeter can yield BP measurements similar to the Doppler derived mean arterial pressure (MAP). We conducted a prospective study consisting of patients with contemporary continuous flow LVADs. In a small pilot phase I inpatient study, we compared direct arterial line measurements with an automated blood pressure (ABP) cuff, Doppler and pulse oximeter derived MAP. Our main phase II study included LVAD outpatients with a comparison between Doppler, ABP, and pulse oximeter derived MAP. A total of five phase I and 36 phase II patients were recruited during February-June 2014. In phase I, the average MAP measured by pulse oximeter was closer to arterial line MAP rather than Doppler (P = 0.06) or ABP (P < 0.01). In phase II, pulse oximeter MAP (96.6 mm Hg) was significantly closer to Doppler MAP (96.5 mm Hg) when compared to ABP (82.1 mm Hg) (P = 0.0001). Pulse oximeter derived blood pressure measurement may be as reliable as Doppler in patients with continuous flow LVADs.

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Section: Resultssupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Pulse Oximeter Derived Blood Pressure Measurement in Patients With a Continuous Flow Left Ventricular Assist Device

et al. 2016

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“…Higher blood pressure has been associated with increases in intracranial hemorrhage, thromboembolic events, and progressive aortic insufficiency [15]. Unfortunately, the reduced pulse pressure during continuous-flow LVAD support limits our ability to accurately measure blood pressure with traditional oscillometric blood pressure cuffs, and Doppler opening blood pressure is commonly used as a surrogate of mean arterial pressure.…”

Section: Measuring Hemodynamics During Lvad Supportmentioning

confidence: 99%

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura

Chung

Nguyen

et al. 2018

Journal of Cardiology

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Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them. In this review, we will discuss the hemodynamic changes following LVAD implantation, and the implications and prognostic impact of hemodynamic optimization on outcomes and complications.

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“…Among them, stroke, bleeding, and right ventricular failure are the most common and serious. [6][7][8] Thus, BP control is paramount in managing VAD patients. 5 Previous clinical trials and observational studies have shown that poorly controlled blood pressure (BP) is strongly associated with stroke and other adverse events.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Doppler blood pressure measurement in continuous‐flow left ventricular assist device patients

Beckman

Welch

et al. 2019

ESC Heart Failure

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Aims Accurate blood pressure (BP) measurement in continuous‐flow ventricular assist device (CF‐VAD) patients is imperative to reduce stroke risk. This study assesses the accuracy of the Doppler opening pressure method compared with the gold standard arterial line method in CF‐VAD patients. Methods and results In a longitudinal cohort of HeartMate II and HVAD patients, arterial line BP and simultaneously measured Doppler opening pressure were obtained. Overall correlation, agreement between Doppler opening pressure and arterial line mean vs. systolic pressure, and the effect of arterial pulsatility on the accuracy of Doppler opening pressure were analysed. A total of 1933 pairs of Doppler opening pressure and arterial line pressure readings within 1 min of each other were identified in 154 patients (20% women, mean age 55 ± 15, 50% HeartMate II and 50% HVAD). Doppler opening pressure had good correlation with invasive mean arterial pressure (r = 0.742, P < 0.0001) and more closely approximated mean than systolic BP (mean error 2.4 vs. −8.4 mmHg). Arterial pulsatility did not have a clinically significant effect on the accuracy of the Doppler opening pressure method. Conclusions Doppler opening pressure should be the standard non‐invasive method of BP measurement in CF‐VAD patients.

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Blood Pressure and Adverse Events During Continuous Flow Left Ventricular Assist Device Support

Cited by 70 publications

References 13 publications

Pulse Oximeter Derived Blood Pressure Measurement in Patients With a Continuous Flow Left Ventricular Assist Device

Pulse Oximeter Derived Blood Pressure Measurement in Patients With a Continuous Flow Left Ventricular Assist Device

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Accuracy of Doppler blood pressure measurement in continuous‐flow left ventricular assist device patients

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