Continuous LVAD monitoring reveals high suction rates in clinically stable outpatients. Issue 7 (1st March 2020)

• Record Type: Journal Article
• Authors: Gross, Christoph; Schima, Heinrich; Schlöglhofer, Thomas; Dimitrov, Kamen; Maw, Martin; Riebandt, Julia; Wiedemann, Dominik; Zimpfer, Daniel; Moscato, Francesco
• Is Part Of: Artificial organs. Volume 44:Issue 7(2020)
• Page Start: E251
• Page End: E262
• Publication Date: 2020-03-01
• Subjects: left ventricular assist device -- mechanical circulatory support -- outpatient monitoring -- overpumping -- suction -- tachycardia; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13638
• Languages: English
• ISSNs: 0160-564X

Abstract

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.