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Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients

Lai, Jacqueline V.*,†; Muthiah, Kavitha*,†,‡; Robson, Desiree*; Prichard, Ros*; Walker, Robyn*; Pin Lim, Choon*; Wang, Louis W.*; Macdonald, Peter S.*,†,‡; Jansz, Paul*; Hayward, Christopher S.*,†,‡

doi: 10.1097/MAT.0000000000000975
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At fixed speed, the spontaneous increase in pump flow accompanying exercise in patients with continuous flow left ventricular assist devices (cfLVADs) is slight in comparison to normal physiologic response, limiting exercise capacity. We systematically exercised 14 patients implanted with an isolated HeartWare HVAD undergoing routine right heart catheterization at baseline and at maximal safe pump speed. In addition to hemodynamics, mixed venous oxygen saturation (SvO2), echocardiography and noninvasive mean arterial pressure, and heart rate were measured. Significantly greater pump flows were achieved with maximum pump speed compared with baseline speed at rest (mean ± standard deviation [SD]: 5.0 ± 0.7 vs. 4.6 ± 0.8 L/min) and peak exercise (6.7 ± 1.0 vs. 5.9 ± 0.9 L/min, p = 0.001). Pulmonary capillary wedge pressure was significantly reduced with maximum pump speed compared to baseline pump speed at rest (10 ± 4 vs. 15 ± 5 mmHg, p < 0.001) and peak exercise (27 ± 8 vs. 30 ± 8 mmHg, p = 0.002). Mixed venous oxygen saturation decreased with exercise (p < 0.001) but was unaffected by changes in pump speed. In summary, although higher pump speeds synergistically augment the increase in pump flow associated with exercise and blunt the exercise-induced rise in left heart filling pressures, elevated filling pressures and markedly diminished SvO2 persist at maximal safe pump speed, suggesting that physiologic flow increases are not met by isolated cfLVADs in the supported failing heart.

From the *Heart Failure and Transplant Unit, St Vincent’s Hospital, Sydney, New South Wales, Australia

Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia

Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.

Submitted for consideration April 2018; accepted for publication in revised form January 2019.

Disclosure: Drs. Prichard and Hayward have received research support from HeartWare Inc. for unrelated studies. Drs. Muthiah, Jansz, and Hayward have received consultancy fees from HeartWare Medtronic. The other authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Reprint requests: Christopher Hayward, Heart Lung Transplant Unit, St Vincent’s Hospital, Victoria St, Darlinghurst NSW 2010 Australia. Email: cshayward@stvincents.com.au.

Copyright © 2019 by the American Society for Artificial Internal Organs