Effects of Continuous-Flow Left Ventricular Assist Device Therapy on Peripheral Vascular Function. Issue 2 (10th May 2021)

• Record Type: Journal Article
• Authors: Kaya, Ersin; Kocabas, Umut; Simsek, Evrim; Nalbantgil, Sanem; Kahraman, Umit; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa; Akilli, Azem
• Is Part Of: ASAIO journal. Volume 68:Issue 2(2022)
• Page Start: 214
• Page End: 219
• Publication Date: 2021-05-10
• Subjects: left ventricular assist device -- heart failure -- peripheral vascular function -- flow-mediated dilation -- pulsatility index; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001447
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 ± 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 ± 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% ( p < 0.001), and median PI decreased from 6.9 to 1.4 ( p < 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% ± 0.9% vs. 7.6% ± 1.1%; p < 0.001, respectively) and (PI: 6.9 ± 1.3 vs. 7.4 ± 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support.