Observational Hemodynamic Monitoring During LVAD Implantation Among Individuals With Advanced Heart Failure

Observational Hemodynamic Monitoring During LVAD Implantation Among

The overall objective of this pilot analysis is to characterize the hemodynamic changes that occur during implantation of a left ventricular assist device (LVAD) in patients with advanced heart failure - specifically, how right ventricular function is compromised as a result of LVAD implantation.

Inclusion Criteria:

• individuals ≥ 18 years of age with severe heart failure (HF) and who have been approved by the advanced HF selection committee for LVAD implantation.

Exclusion Criteria:

• Patients with pre-existing right ventricular (RV) dysfunction/failure, defined as:

  1. Imaging evidence of moderate-severe RV dysfunction on echocardiography

  2. Hemodynamic evidence of RV dysfunction with:

     • a right-atrial pressure (RAP): pulmonary capillary wedge pressure (PCWP) ratio of ≥ 0.67 (note: this index compares pressures on the right [RAP] and left [PCWP] side of the heart;
     • an RAP/PCWP ratio ≥ 0.67 provides hemodynamic evidence of RV dysfunction.

  3. Clinical evidence of preexisting RV dysfunction, as indicated by significant (3-4+ peripheral edema) and/or elevated jugular venous pressures on clinical examination.

  4. Patients with end-stage renal disease requiring hemodialysis

  5. Patients requiring temporary hemodynamic support prior to LVAD implantation with temporary LVADs, and/or veno-arterial extracorporeal membrane oxygenators ("ECMO").

  6. Planned concurrent implantation of right ventricular assist device