Long-term trajectories of invasive hemodynamic parameters and clinical outcomes after durable left ventricular assist device implantation

Background Long-term hemodynamic changes after durable left ventricular assist device (LVAD) implantation are not well characterized. Characterizing these trajectories is clinically relevant, as persistent or evolving abnormalities in filling pressures and pulmonary circulation may identify patients at risk for adverse outcomes. Method We conducted a retrospective single-center study including all patients who underwent durable LVAD implantation at the University Medical Center Groningen (2012–2025). We evaluated serial right heart catheterization (RHC) measurements to describe hemodynamic trajectories. Repeated measures, mixed-effect models were used to analyze hemodynamic trajectories up to 60 months of follow up, including mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP) and pulmonary artery pulsatility index (PAPi). Trajectories were compared according to survivor status, baseline LVAD strategy, development of late right ventricular failure (RVF), presence of aortic regurgitation (AR), and worsening renal function (WRF). Results Among 199 patients (176 HeartMate 3; 23 HeartMate II), mean PAP (−10.1 mmHg, 95% CI −13.1 to −7.1) and PCWP (−9.9 mmHg, 95% CI −12.5 to −7.2) decreased significantly within the first 6 months after LVAD implantation, while RAP (0.0 mmHg, 95% CI −0.8 to 0.8) remained unchanged. Cardiac index (+0.6 L/min/m², 95% CI 0.4−0.8) and cardiac output (+1.3 L/min, 95% CI 0.9−1.7) increased significantly over the same interval. Beyond 6 months, trajectories for most hemodynamic parameters remained generally stable. Non-survivors and patients developing late RVF showed consistently higher filling pressures with trajectories largely parallel to those of survivors or those without RVF. Hemodynamic trajectories did not differ by initial LVAD strategy. In contrast, clinically significant aortic regurgitation and WRF were associated with distinct hemodynamic trajectories. Conclusion Hemodynamic parameters after durable LVAD implantation improved early and remained largely stable thereafter. Patients with adverse clinical outcomes showed persistently higher and/or altered hemodynamic profiles. These findings suggest that longitudinal hemodynamic assessment may enable early identification of patients at risk for adverse outcomes.