LAUSR

Introduction: LVAD (Left Ventricle Assist Device) represents a valid alternative to heart transplantation in patients who suffer from end stage heart failure. The ventricular devices show a different performance related to preload, afterload and the fixed setted revolutions per minute (RPM). Our main intention was to introduce a new hemodynamic index that accounting for the RPM setted, can easily identify different hemodynamic profiles occurring during LVAD support. Methods: From november 2015 to march 2018, 19 patients implanted with HM 3 underwent ramp tests during right heart catheterization. Basal data were collected and Hemodynamic Index (HI) was calculated according to the following formula: HI = {[PAM - PCWP]/CVP}* {[RPM SETTED*100]/MAX RPM} where the first term is the ratio between afterload and preload and the second term means the ratio between the RPM setted and the maximal rpm available. Results: Basal HI was 455 ± 142. In 8 patients (42%) an index less than 400 was found. Three main profiles could be identified. Profile 1 HI less than 300 and higher risk of right failure. Profile 2 HI between 300 and 600, requiring speed optimization, Profile 3 HI> 600 requiring afterload optimization. After a tailored therapy including speed and anti hypertensive optimization a better HI (583 ± 224)was obtained. Conclusion: RPM should be setted balancing an optimal unloading with adequate afterload and preload and accounting for the right ventricular function. We proposed a new hemodynamic index that integrating different variables can stratify patients in three main profiles according to which the best treatment can be provided.