Thorac Cardiovasc Surg 2013; 61 - OP103
DOI: 10.1055/s-0032-1332342

Slight exercise in ambulatory LVAD patients leads to a severe compromise of hemodynamic parameters

D Camboni 1, T Lange 2, P Ganslmeier 1, B Flörchinger 1, M Amann 3, L Rupprecht 1, S Hirt 1, M Hilker 1, C Schmid 1
  • 1Universitätsklinikum Regensburg, Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Regensburg, Germany
  • 2Universitätsklinikum Regensburg, Innere Medizin II, Regensburg, Germany
  • 3Universitätsklinikum Regensburg, Klinik für Anästhesiologie, Regensburg, Germany

Objective: The effects of exercise during left ventricular support are still a matter or research. This study aimed to evaluate exercise in LVAD patients by different diagnostic tools in a systematic fashion.

Methods: Ambulatory patients (n = 8, age 45 ± 13 y, NYHA 2) on left ventricular support (Berlin Heart INCOR®, mean support time 465 ± 257 d, mean support 4 ± 0.3 l/min) on an outpatient basis were exercise evaluated by the means of cycle ergospirometry followed by right heart catheterization during slight cycle exertion (20 watt [W]) through the upper extremity.

Results: The maximum possible strain over 6 ± 1.2 min during ergospirometry was determined to be 69 ± 13 W (35% of normal quota [NQ]). Peak oxygen uptake was 12 ± 2 ml/kg/min (38% NQ). Heart rate increased significantly from 86 ± 11 beats/min to 125 ± 22 beats/min (69% NQ; p = 0.001). Arterial lactate concentration increased significantly from 9 ± 2 mg/dl to 40 ± 24 mg/dl (p = 0.006).The results of the right heart catheterization on a seating cycle with a controlled 20 W strain are depicted in figure 1. In summary, cardiac output increased moderately from 4.7 ± 0.5 l/min to 6.2 ± 1.0 l/min (increase 24%; p = 0.008) at the cost of a 50% increase in pulmonary wedge pressure (p = 0.01), a 40% increase in mean pulmonary artery pressure (p > 0.001) and a 55% increase in right atrial pressure (p = 0.007) leading to a significant fall in mixed venous saturation from 58 ± 6% to 32 ± 9% (p < 0.001).

Fig. 1: Hemodynamic Summary

Abbr.: PCW= pulmonary capillary wedge pressure; RA= right atrial pressure; PA [mmHg]= pulmonary artery pressure; RR= blood pressure (2 pts); PVR= pulmonary vascular resistance; SVR= systemic vascular resistance, PA [%]= mixed venous saturation

Conclusion: Despite left ventricular support slight exercise leads to severe compromise of hemodynamic parameters. Physicians taking care of this patient population must be aware of exertion effects in LVAD patients.