Clinical hemodynamic evaluation of patients implanted with a fully magnetically levitated left ventricular assist device (HeartMate 3)

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• 作者：Nir Uriel ; MD ; MSc^a ; ^{nuriel@medicine.bsd.uchicago.edu} ; Sirtaz Adatya ; MD^a ; Jiří ; Malý ; MD ; PhD^b ; Eric Kruse ; RDCS^a ; Daniel Rodgers^a ; Gerald Heatley ; MS^c ; Ale&scaron ; Herman ; MD ; PhD^b ; Poornima Sood ; MD^c ; Dominik Berliner ; MD^d ; Johann Bauersachs ; MD^d ; Axel Haverich ; MD ; PhD^d ; Michael Želí ; zko ; MD ; PhD^b ; Jan D. Schmitto ; MD ; PhD^d ; ¹ ; Ivan Netuka ; MD ; PhD^b ; ¹
• 关键词：left ventricular assist device ; magnetic levitation ; hemodynamic evaluation ; ramp test ; device optimization
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：36
• 期：1
• 页码：28-35
• 全文大小：1525 K
• 卷排序：36

文摘

The HeartMate 3 (HM3) is a Conformiteé Européenne (CE) mark–approved left ventricular assist device (LVAD) with a fully magnetically levitated rotor with features consisting of a wide range of operational speeds, wide flow paths and an artificial pulse. We performed a hemodynamic and echocardiographic evaluation of patients implanted with the HM3 LVAD to assess the speed range for optimal hemodynamic support.MethodsSixteen HM3 patients underwent pump speed ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP] and blood pressure [BP]) and 3-dimensional echocardiography (3DE). Data were recorded at up to 13 speed settings. Speed changes were in steps of 100 revolutions per minute (rpm), starting at 4,600 rpm and ramping up to 6,200 rpm.ResultsMean original speed was 5,306 ± 148 rpm, with a majority of patients (10 of 16, 62.5%) having normal CVPs and PCWPs at their original rpm settings. Going from lowest to highest speeds, cardiac output improved at the rate of 0.08 ± 0.08 liter/min per 100 rpm (total change 1.25 ± 1.20 liters/min) and PCWP decreased at the rate of –0.48 ± 0.27 mm Hg per 100 rpm (total change –6.13 ± 3.72 mm Hg). CVP and systolic BP did not change significantly with changes in rpm. Left ventricular end-diastolic dimension (LVEDD) decreased at a rate of –0.15 ± 0.09 cm per 100 rpm. Number of rpm was adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in 13 (81.3%) patients. For the remaining 3 patients, medical management was pursued to optimize hemodynamic support.ConclusionHemodynamic normalization of pressures was achieved in the majority of patients implanted with the HM3 pump within a narrow speed range.