Changes in Spirometry After Left Ventricular Assist Device Implantation

Mohamedali, Burhan; Bhat, Geetha; Yost, Gardner; Tatooles, Antone

doi:10.1111/aor.12507

Cited by 14 publications

(9 citation statements)

References 28 publications

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“…Remarkably, the study data showed a profound decrease in pulmonary D LCO post-LVAD implantation consistent with findings of Mohamedali et al 18 This decline remained significant when corrected for V A (Figure 2) and was clearly evident in subsequent analyses of the 6MG and 12MG.…”

Section: Diffusing Capacity Of the Lung For Carbon Monoxidesupporting

confidence: 90%

Pulmonary function assessment post‐left ventricular assist device implantation

et al. 2018

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AimThe lungs—and particularly the alveolar‐capillary membrane—may be sensitive to continuous flow (CF) and pulmonary pressure alterations in heart failure (HF). We aimed to investigate long‐term effects of CF pumps on respiratory function.Methods and resultsWe conducted a retrospective study of patients with end‐stage HF at our institution. We analysed pulmonary function tests [e.g. forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)] and diffusing capacity of the lung for carbon monoxide (D LCO) from before and after left ventricular assist device (LVAD) implantation and compared them with invasive haemodynamic studies. Of the 274 patients screened, final study analysis involved 44 patients with end‐stage HF who had CF LVAD implantation between 1 February 2007 and 31 December 2015 at our institution. These patients [mean (standard deviation, SD) age, 50 (9) years; male sex, n = 33, 75%] received either the HeartMate II (Thoratec Corp.) pump (77%) or the HeartWare (HeartWare International Inc.) pump. The mean (SD) left ventricular ejection fraction was 21% (13%). At a median of 237 days post‐LVAD implantation, we observed significant D LCO decrease (−23%) since pre‐implantation (P < 0.001). ΔD LCO had an inverse relationship with changes in pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) from pre‐LVAD to post‐LVAD implantation: ΔD LCO to ΔPCWP (r = 0.50, P < 0.01) and ΔD LCO to ΔRAP (r = 0.39, P < 0.05). We observed other reductions in FEV1, FVC, and FEV1/FVC between pre‐LVAD and post‐LVAD implantation. In mean (SD) values, FEV1 changed from 2.3 (0.7) to 2.1 (0.7) (P = 0.005); FVC decreased from 3.2 (0.8) to 2.9 (0.9) (P = 0.01); and FEV1/FVC went from 0.72 (0.1) to 0.72 (0.1) (P = 0.50). Landmark survival analysis revealed that ΔD LCO from 6 months after LVAD implantation was predictive of death for HF patients [hazard ratio (95% confidence interval), 0.60 (0.28–0.98); P = 0.03].ConclusionsPulmonary function did not improve after LVAD implantation. The degree of D LCO deterioration is related to haemodynamic status post‐LVAD implantation. The ΔD LCO within 6 months post‐operative was associated with survival.

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Section: Diffusing Capacity Of the Lung For Carbon Monoxidesupporting

confidence: 90%

Pulmonary function assessment post‐left ventricular assist device implantation

et al. 2018

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“…A reduced ventilation efficiency (Ve/ VCO2>35) was measured in 52 patients (63%). It is unclear whether respiratory function improves after CF-LVAD implantation [24,25], but it is commonly agreed that CF-LVAD patients show an impaired respiratory muscle function and/or ventilation-perfusion mismatch [4].…”

Section: Limiting Factors Of Submaximal Exercisementioning

confidence: 99%

Limiting factors of peak and submaximal exercise capacity in LVAD patients

et al. 2020

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Aims Although patients supported with a Continuous-Flow Left Ventricular Assist Device (CF-LVAD) are hemodynamically stable, their exercise capacity is limited. Hence, the aim of this work was to investigate the underlying factors that lead to peak and submaximal exercise intolerance of CF-LVAD supported patients. Methods Seven months after CF-LVAD implantation, eighty three patients performed a maximal cardiopulmonary exercise test and a six minute walk test. Peak oxygen uptake and the distance walked were measured and expressed as a percentage of the predicted value (%VO2p and %6MWD, respectively). Preoperative conditions, echocardiography, laboratory results and pharmacological therapy data were collected and a correlation analysis against %VO2p and %6MWD was performed. Results CF-LVAD patients showed a relatively higher submaximal exercise capacity (%6MWD = 64 ±16%) compared to their peak exertion (%VO2p = 51±14%). The variables that correlated with %VO2p were CF-LVAD parameters, chronotropic response, opening of the aortic valve at rest, tricuspid insufficiency, NT-proBNP and the presence of a cardiac implantable electronic device. On the other hand, the variables that correlated with %6MWD were diabetes, creatinine, urea, ventilation efficiency and CF-LVAD pulsatility index. Additionally, both % 6MWD and %VO2p were influenced by the CF-LVAD implantation timing, calculated from the occurrence of the cardiac disease. Conclusion Overall, both %6MWD and %VO2p depend on the duration of heart failure prior to CF-LVAD implantation. %6MWD is primarily determined by parameters underlying the patient's general condition, while %VO2p mostly relies on the residual function and chronotropic

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“…Nevertheless, general health conditions of both experimental animals were mostly stable, with no dramatic disturbances. Mohamedali et al reported in their recent paper significant reduction of pulmonary functions resulting from long-term implantation of LVAD (22). In both HF-TAH experiments the dominant histological finding in samples from kid-neys was a proteinaceous material in lumen of glomeruli and tubules.…”

Section: Discussionmentioning

confidence: 95%

“…Clinical and experimental studies also indicate that long-term implantation of circulation support devices may be related to more or less extensive changes of the respiratory system. Mohamedali et al reported in their recent paper significant reduction of pulmonary functions resulting from long-term implantation of LVAD (22). Baba et al observed in their experiments with UPTAH signs of intra-alveolar edema, hemorrhagic foci, pulmonary vessels thrombosis, atelectasis, and various degrees of inflammatory infiltration (18).…”

Section: Discussionmentioning

confidence: 99%

Histopathology Image Analysis in Two Long‐Term Animal Experiments with Helical Flow Total Artificial Heart

Wotke

Homolka²,

Vasků

et al. 2016

Artificial Organs

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Histopathological analysis can provide important information in long-term experiments with total artificial heart (TAH). Recently, a new type of blood pump, the helical flow total artificial heart (HF-TAH) was developed. This study aimed to investigate the changes in selected vital organs in animal experiments with implanted HF-TAH. Samples from lung, liver, and kidneys from two female goats (No. 1301 and No. 1304) with implanted HF-TAH were analyzed. Tissue samples were fixed in 10% formaldehyde and 4 µm thick transverse sections were stained with hematoxylin-eosin (HE). Additional staining was done for detection of connective tissue (Masson-Goldner stain) and for detection of iron (hemosiderin) deposits (Perls stain). Sections were scanned at 100× and 500× magnification with a light microscope. Experiment no. 1301 survived 100 days (cause of termination was heavy damage of the right pump); experimental goat no.1304 survived 68 days and was sacrificed due to severe right hydrodynamic bearing malfunction. Histopathological analysis of liver samples proved signs of chronic venostasis with limited focal necrotic zones. Dilated tubules, proteinaceous material in tubular lumen, and hemosiderin deposits were detected in kidney samples. Contamination of the organs by embolized micro-particles was suspected at the autopsy after discovery of visible damage (scratches) of the pump impeller surface (made from titanium alloy) in both experiments. Sporadic deposits of foreign micro-particles (presumably titanium) were observed in most of the analyzed parenchymal organs. However, the described deposits were not in direct connection with inflammatory reactions in the analyzed tissues. Histopathological analysis showed the presence of minimal contamination of the lung, kidney, and liver tissue samples by foreign material (titanium very likely). The analysis showed only limited pathological changes, especially in liver and kidneys, which might be attributed to the influence of artificial perfusion often observed in chronic TAH experiments.

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Changes in Spirometry After Left Ventricular Assist Device Implantation

Cited by 14 publications

References 28 publications

Pulmonary function assessment post‐left ventricular assist device implantation

Pulmonary function assessment post‐left ventricular assist device implantation

Limiting factors of peak and submaximal exercise capacity in LVAD patients

Histopathology Image Analysis in Two Long‐Term Animal Experiments with Helical Flow Total Artificial Heart

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