Continuous LVAD monitoring reveals high suction rates in clinically stable outpatients

Abstract

Suction of the left ventricle can lead to potentially life‐threatening events in left ventricular assist device (LVAD) patients. With the resolution of currently available clinical LVAD monitoring healthcare professionals are unable to evaluate patients’ suction occurrences in detail. This study investigates occurrences and durations of suction events and their associations with tachycardia in stable outpatients. Continuous high‐resolution LVAD data from HVAD patients were analyzed in the early outpatient period for 15 days. A validated suction detection from LVAD signals was used. Suction events were evaluated as suction rates, bursts of consecutive suction beats, and clusters of suction beats. The occurrence of tachycardia was analyzed before, during, and after suction clusters. Furthermore, blood work, implant strategy, LVAD speed setting, inflow cannula position, left ventricular diameters, and adverse events were evaluated in these patients. LVAD data of 10 patients was analyzed starting at 78 ± 22 postoperative days. Individuals’ highest suction rates per hour resulted in a median of 11% (range 3%‐61%). Bursts categorized as consecutive suction beats with n = 2, n = 3‐5, n = 6‐15, and n > 15 beats were homogenously distributed with 10.3 ± 0.8% among all suction beats. Larger suction bursts were followed by shorter suction‐free periods. Tachycardia during suction occurred in 12% of all suction clusters. Significant differences in clinical parameters between individuals with high and low suction rates were only observed in left ventricular end‐diastolic and end‐systolic diameters (P < .02). Continuous high‐resolution LVAD monitoring sheds light on outpatient suction occurrences. Interindividual and intraindividual characteristics of longitudinal suction rates were observed. Longer suction clusters have higher probabilities of tachycardia within the cluster and more severe types of suction waveforms. This work shows the necessity of improved LVAD monitoring and the implementation of an LVAD speed control to reduce suction rates and their concomitant burden on the cardiovascular system.

Ventricular arrhythmias following continuous‐flow left ventricular assist device implantation: A systematic review

“…In fact, such improvements in pump monitoring may be a means of better understanding the sequelae of suction events. In the HeartWare HVAD, improved monitoring of CF‐LVAD pump data detected suction events that occur in the outpatient setting, with 12% of these suction clusters resulting in tachycardia . Improvements in CF‐LVAD pump monitoring in the future may be key to better understanding suction events and their relationship to VA.…”

Optimal cannula positioning of HeartMate 3 left ventricular assist device

“…Narrow CCA represents an inflow cannula position that is more directed toward the mitral valve, allowing for more efficient LV unloading. 17 Three-dimensional computed tomography may better clarify the relationship between the cannula position and other anatomical components of LV, including the septum and the mitral valve. 18 We believe that CXR measurement has an advantage for quantifying device position in daily practice due to its availability and ease of use.…”

Out of hospital management of LVAD patients during COVID‐19 outbreak

“…Therefore, specific management algorithms should be implemented by every implanting and referring LVAD center to aim for early diagnosis and treatment of COVID‐19 or LVAD complications. A continuous telemonitoring system based on a fully digitalized structure is surely desirable, 4‐7 yet not available in every LVAD center. On the other side, our telemonitoring algorithm has been designed to be sustainable, enforceable, and adaptable to every LVAD center, regardless of number of LVAD patients or previous experiences.…”