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Passive Leg Raising After Left Ventricular Assist Device Implantation

Ram, Eilon*; Dourov, Daniil; Berkenstadt, Haim; Lavee, Jacob*; Kassif, Yigal*; Peled-Potashnik, Yael§; Kogan, Dina*; Preisman, Sergey; Raanani, Ehud*; Kogan, Alexander*

doi: 10.1097/MAT.0000000000000870
Adult Circulatory Support
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Left ventricular assist device (LVAD) implantation is a common procedure in patients with end-stage heart failure. Although optimal fluid management is essential for acceptable postoperative treatment, it is critical to identify which patients will benefit from fluid administration. Passive leg raising (PLR) is a validated dynamic method that predicts fluid responsiveness in patients with heart failure by inducing a transient increase in cardiac preload. We performed a prospective study on 20 consecutive patients who underwent PLR maneuvers after LVAD implantation. Left ventricular assist device flow, end-tidal carbon dioxide, central venous pressure (CVP), and mean arterial pressure (MAP) were measured before and after PLR. Passive leg raising responsiveness was defined as at least a 15% increase in LVAD flow: (11 were responders and 9 nonresponders). Of the responders, 7 had right ventricular dysfunction (≥3). Passive leg raising responsiveness was associated with an increase of 19% in the LVAD flow, the mean CVP was raised from 11.3 to 14.4 mm Hg and the MAP from 82.6 to 86.7 mm Hg. After PLR, end-tidal carbon dioxide was increased by 4.6 mm Hg in the responders and 1.1 mm Hg in the nonresponders. The PLR maneuver is a noninvasive and easy to perform method that uses LVAD flow to assess fluid responsiveness in patients with heart failure after LVAD implantation.

*Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Department of Anesthesia, The Baruch Padeh Medical Center, Poria, Israel

Department of Anesthesia, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

§Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.

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Submitted for consideration April 2018; accepted for publication in revised form July 2018.

Disclosure: The authors have no conflicts of interest to report.

The abstract of this article was presented as an oral presentation at the 24th International Conference of the Israel Society of Anesthesiologists jointly with the Israel Society of Critical Care Medicine, November 7, 2017, Tel Aviv, Israel.

The investigators initiated the study, had full access to and analyzed all the data, and wrote the article.

Correspondence: Eilon Ram, Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel 52621. Email: eilon.ram@sheba.health.gov.il.

Copyright © 2019 by the American Society for Artificial Internal Organs