Continuous LVAD monitoring reveals high suction rates in clinically stable outpatients.
Aged
Echocardiography, Doppler, Color
Echocardiography, Doppler, Pulsed
Female
Heart Failure
/ surgery
Heart Ventricles
/ diagnostic imaging
Heart-Assist Devices
/ adverse effects
Hemodynamic Monitoring
Humans
Male
Middle Aged
Models, Cardiovascular
Postoperative Complications
/ diagnosis
Suction
Ventricular Function, Left
/ physiology
left ventricular assist device
mechanical circulatory support
outpatient monitoring
overpumping
suction
tachycardia
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
16
08
2019
revised:
08
01
2020
accepted:
08
01
2020
pubmed:
17
1
2020
medline:
13
4
2021
entrez:
17
1
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 31945201
doi: 10.1111/aor.13638
pmc: PMC7318142
doi:
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E251-E262Subventions
Organisme : Austrian Science Fund
ID : KLI357
Informations de copyright
© 2020 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals, Inc.
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