Long-term hemodynamic trends after LVAD implantation

Background

Long-term hemodynamic changes after LVAD implantation are not well characterized. We assessed serial right heart catheterization (RHC) measurements to describe hemodynamic trajectories during long-term durable LVAD support.

Method

We conducted a retrospective single-center study including all HeartMate II and HeartMate 3 recipients in our University Medical Center (2012–2025). Mixed-effects models were used to evaluate hemodynamic trajectories up to 60 months follow up. Parameters included pulmonary artery pressures, PCWP, RAP, PVR, SVR, CO, CI, RVSWI, and PAPi. Pairwise comparisons were performed at fixed postoperative timepoints (6, 12, 24, 36, 48, and 60 months). Sub analyses examined differences by survival status, LVAD strategy, and clinical right ventricular failure.

Results

Among 199 patients (176 HeartMate 3; 23 HeartMate II), pulmonary pressures (mPAP −10.1 mmHg, 95% CI −13.1 to −7.1) and PCWP (−9.9 mmHg, 95% CI −12.5 to −7.2) decreased significantly within the first 6 months after LVAD implantation, while RAP (0.0 mmHg, 95% CI −0.8 to 0.8) remained unchanged. Cardiac index (0.6 L/min/m², 95% CI 0.4−0.8) and cardiac output (1.3 L/min, 95% CI 0.9−1.7) increased significantly over the same interval. Beyond 6 months, trajectories for most hemodynamic parameters were generally stable.

Non-survivors showed trajectories for mPAP, PCWP and RAP which were generally higher compared with survivors, while PAPi consistently remained <2. Patients with RV failure showed similar hemodynamic trajectories to non-survivors, although PAPi trajectories did not differ significantly between patients with and without RV failure. Hemodynamic trajectories did not differ by initial LVAD strategy.

Conclusion

LVAD support results in early and sustained reductions in pulmonary and cardiac filling pressures. Distinct hemodynamic trajectories were observed in patients who died or developed right ventricular failure, characterized by higher filling pressures and persistently low PAPi. These patterns may carry prognostic relevance during long-term LVAD follow-up.Figure 2For image description, please refer to the figure legend and surrounding text.