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Purpose Nutritional Risk Index (NRI), a measure of malnutrition, is a simple and rapid method to calculate individual nutritional risk of patients with Stage D Heart Failure (HF). We sought to determine whether NRI is an independent predictor of mortality in Stage D HF patients who require left ventricular assist device (LVAD) support. Methods We retrospectively reviewed patients who underwent LVAD implantation at an academic medical center between 1/1/2012 and 12/31/2017. We reviewed pre-VAD nutritional evaluations and prior clinical data to include key pre-VAD blood test results to calculate NRI using the formula (15.19 × serum albumin [in g/dl]) + (41.7 × weight [in kg] / ideal body weight [in kg]). Each individual was then categorized as low or high NRI based on being below or above/equal to the median pre-LVAD NRI. Baseline demographics and metabolic profiles were compared for patients with lower vs higher NRI using unpaired T tests and Fisher exact tests, as appropriate. Adjusted and unadjusted Cox models were constructed to examine the impact of NRI on mortality post-LVAD implant. Results Amongst 81 patients undergoing LVAD implantation, the mean albumin pre-LVAD implantation was 3.6 ±0.5 g/dL, mean BMI was 30.3 ±6.3 kg/m2 and the mean NRI was 96.4 ±7.2 (median 96.5, IQR 84.2 - 107). Patients with a lower NRI (n=40) had a lower body mass index than those with a higher NRI (BMI, 28.3 ±5.4 vs 32.2 ±6.5 kg/m2) and lower pre-albumin levels (17.9 ±6.5 vs 21.8 ±6.6 mg/dL), but were equivalent for age (55 ±12.4 vs 52 ±12.0 years), sex (40 vs 37% females), total cholesterol (127 ±36.1 vs 129 ±27.5 mg/dL) and glycosylated hemoglobin (6.2 ±1.4 vs 6.5 ±1.2%). Thirteen (33%) patients with lower NRI died during LVAD support, vs 9 (22%) with higher NRI. NRI was a significant predictor of mortality on LVAD support in both the unadjusted (hazard ratio, HR, 0.94, 95% 0.88-0.99 per 1-unit NRI, p=0.03) and after adjustment (HR 0.92, 95% CI 0.86-0.98, p=0.016) for age, sex, total cholesterol, and glycosylated hemoglobin. Conclusion Lower NRI was an independent predictor of mortality post-LVAD implantation. This finding suggests NRI, as a measure of malnutrition, may help better risk stratify patients being evaluated for LVAD therapy. [ABSTRACT FROM AUTHOR]

The purpose of this research was to study the changes in mitral valve apparatus after placement of continuous flow LVAD. These data can help determine if additional mitral valve intervention is needed at the time of LVAD placement. A retrospective review of data of all the LVAD placed in the hospital from 2012 through March 31st 2020 were done. Demographic, clinical variables and clinical outcomes were obtained from electronic medical records. The echocardiographic variables were obtained by two authors with standardized guidelines agreed upon before initiation of the study; this required review of all the images and identification of some unique variables dedicated to the study of mitral valve apparatus. The echocardiogram performed closest before LVAD placement and the last echocardiogram performed within one year after LVAD placement were evaluated to allow reflection of the worst pre-LVAD and the best post-LVAD state of the mitral valve apparatus. Of total of 145 patients who had LVAD during the study period, 88 patients were identified with pre-specified minimum available echocardiographic variables. 9 did not have significant pre-existing mitral regurgitation (MR). 69 patients had improvement from "moderate or severe" to "mild or none". 10 patients did not show any improvement in the severity of MR: 8 from mild and 2 from moderate MR. All severe MR improved. The changes in mitral valve apparatus included (all reduction): left ventricular end diastolic dimension by 9 (+/-14.98) mm; left atrial volume index by 16.2 (+/- 14.73) ml/m2; annulus size by 5 (+/- 7.94) mm; apical displacement by 2 (+/- 3.91) mm; posterior displacement by 2 (+/- 4.7) mm; tethering area by 85 (+/- 104.94) mm2 and papillary muscle displacement by 2 (+/- 9.55) mm. Changes in mitral valve apparatus were similar in those who had improvement of MR or not except the reduction in posterior displacement happened more in those who had improvement in MR severity. Continuous flow LVAD favorably improves mitral valve apparatus and MR severity. Prevalence of clinically significant residual MR is low. More data is needed to understand the changes in mitral valve apparatus and guide if any concomitant mitral valve intervention is needed with LVAD placement. [ABSTRACT FROM AUTHOR]

Purpose Right ventricular assist device (RVAD) support can be beneficial in a variety of clinical scenarios including post cardiotomy RV failure, cardiogenic shock, and severe acute hypoxemic respiratory failure with associated RV dysfunction. Reported mortality after RVAD insertion ranges from 37% to 46%. Percutaneous RVAD support via right internal jugular vein has emerged with the potential for enhanced weaning and ambulation strategies. However, the experience with such an approach remains limited. Methods A comprehensive retrospective review was completed for all patients receiving percutaneous RVAD support via a right internal jugular route at our institution between April 2017 and September 2018. Successful weaning from support, in-hospital mortality, and freedom from device related complications were assessed. Results Percutaneous RVAD support was instituted in 31 patients (22 men, 71%) with a median age of 58 years (19 to 77 years). Indications for implantation were divided into 3 groups. Group 1: Post cardiotomy support (n=18, 58%) including following LVAD insertion, pulmonary thromboendarterectomy, bilateral lung transplant, or cardiac transplantation, Group 2: Cardiogenic shock (n=7, 23%), and Group 3: Primary respiratory failure (n=6, 19 %). There were no failures to wean RVAD in Group 1, compared with 67% failure to wean in Group 2 and 33% in Group 3. Median duration of support in Group 1 was 16 (7-36) days, 5 (1-16) days in Group 2, and 13 (8-18) days in Group 3. All-cause mortality for the entire cohort was 29%. Mortality in Group 1 was 2/18 (11%), Group 2 was 4/7 (57%), and Group 3 was 3/6 (50%). Complications included postoperative bleeding requiring reoperation in 7 (23%) patients, device related superior vena cava obstruction in 3 patients (10%), and device migration in 2 (6%) patients. There were no device-related infections, DVT, valvular damage, or pulmonary emboli observed in this cohort. No patients required transition to implantable long-term RVAD. Conclusion Percutaneous RVAD support appears to be a versatile and effective tool for treating patients with severe RV failure, with best outcomes in the post cardiotomy group. The ability to ambulate these patients while on support and remove the device at the bedside without surgery may permit a more liberal use of this technology with improvements in outcomes in RV failure. [ABSTRACT FROM AUTHOR]

Purpose Right ventricular (RV) failure is a frequent complication of left ventricular assist device (LVAD) implantation in patients with end-stage heart failure, impacting 20% of patients. Percutaneous support can be used in this scenario, however prior data supporting this approach showed survival at 30 days or hospital discharge was only 60%. Methods Retrospective review was conducted of all patients who developed severe RV failure requiring percutaneous right ventricular assist device (RVAD) following durable LVAD implant between 01/01/2017 and 07/31/2018. Patient demographics were reviewed in addition to key hemodynamic and laboratory values were collected pre-RVAD implantation and at the time of explant (post-RVAD). Pre-RVAD and post-RVAD data was compared using paired T tests. Survival at 30 days or at date of hospital discharge (whichever was longer) was considered as the primary outcome. Patient hemodynamic measures were evaluated as secondary outcomes. Results Of 41 patients who received LVAD, 10 (24%) developed severe RV failure postoperatively. Baseline characteristics include age 51±14.5 years, with 30% females. Incidence of ischemic cardiomyopathy was 20%. Most patients received LVAD as destination therapy (80%). RVAD support via percutaneous cannulation was maintained for a median duration of 15.5 days (Range - 7 to 23 days). Survival at 30 days or to hospital discharge was 100%. We observed a reduction in central venous pressure from 17.2±4.5 mm(Hg) to 11±3.1 mm(Hg), p=0.004 and an increase in LVAD flow from 4.5±0.8 l/min to 5.1±0.4 l/min, p=0.018. There was a trend towards increase in mixed venous oxygen saturation from 61.5±11.1% to 67.0±7.0%, p=0.224. Conclusion Percutaneous RVAD cannulation for treatment of RV failure after LVAD implantation provides superior early postoperative survival than traditional management techniques. These findings support broader implementation of this technique to further characterize its benefit. [ABSTRACT FROM AUTHOR]