Abstract Background Ventricular assist device (VAD) mechanical circulatory support is increasingly being used as a bridge to transplant and destination therapy for patients with end-stage heart failure. Optimising haemodynamic profiles in VAD patients is crucial for reduction in morbidity and mortality and is largely influenced by pump characteristics. Purpose The primary aim of this study was to determine whether transthoracic echocardiography (TTE)-guided speed optimisation study improved haemodynamic outcomes in VAD patients, compared to standalone clinical assessment. Methods This single centre, retrospective study, compared haemodynamic outcomes in forty-six patients that underwent HeartMate 3 LVAD (74%) or BiVAD (26%) implantation and baseline and 3-month post-implantation invasive haemodynamic testing with right heart catheterisation (RHC). Results Nineteen patients (49±12 years, 90% male) had speed optimisation and twenty-seven patients (50±14 years, 78% male) standard management. At follow up RHC, there was a significant increase in pump speed in the optimised group (5405±94 revolutions per minute (rpm) at baseline versus 5647±98 rpm at follow-up, p=0.02), but not in the non-optimised group. The optimised group demonstrated a significantly lower right atrial pressure (RAP 5.4±0.7 mmHg versus 8.2±0.8 mmHg, p=0.01) and pulmonary capillary wedge pressure (PWCP 9.8±1.1 mmHg versus 13.1±1.1 mmHg, p0.05) compared to the non-optimised group. In addition, the optimised group had a significantly greater reduction in PCWP (19.2±1.9 mmHg versus 11.5±2.2 mmHg, p=0.02) and a trend to a greater reduction in pulmonary arterial systolic pressure (30.7±2.7 mmHg versus 21.8±3.7 mmHg, p=0.08) compared to the non-optimised group. There was also a significantly lower use of sildenafil in the optimised compared to the non-optimised group (42% versus 74%, p=0.03). There were no significant differences in changes in renal function and left ventricular end-diastolic dimension between the groups. Conclusion TTE-guided speed optimisation in VAD patients improved haemodynamic profiles and reduced pulmonary vasodilator use, compared to standard care. Incorporation of speed optimisation to improve ventricular offloading should be considered as a useful adjunct in the care of VAD patients.
Dragaš et al. (Sat,) studied this question.