Background
The use of left ventricular assist devices (LVAD) widely increased in the past decade due to
the lack of donor organs and the rising prevalence of heart failure. This therapy should lead
patients in good condition to heart transplantation (bridge to transplant) or improve their quality
of life (destination therapy). LVAD support is nowadays considered as an alternative to heart
transplantation, however improvement in exercise performance is inconsistently
demonstrated. The current study sought to quantitate physical capacity prior and subsequent
LVAD implantation in order to assess the impact of this therapy.
Methods and Results
This study is a quantitative, observational, prospective, mono-centric trial which aimed to
assess exercise capacity and its changes prior and subsequent LVAD implantation, using
cardiopulmonary exercise testing (CPET), in patients suffering from refractory end-stage heart
failure undergoing LVAD therapy with HeartMate 3 between 2017 and 2018 at the cardiac
surgery department at CHUV. 21 patients underwent LVAD therapy during the study period,
yet only 5 were included. CPET were completed an average of 11 months following
implantation. Although VO2
max improved by approximately 30% subsequent LVAD
implantation, from 9,60 ± 3,88 ml/kg/min to 12,46 ± 3,16 (t-test=-2,424; ddl=4; p=0,072), it was
not statistically significant and remained considerably lower than predicted values.
Nonetheless, improvement by at least one NYHA class was seen in 100% of patients, with
80% improving by two classes. As a result of the limited study sample size, firm reliance lacks
between patients related clinical parameters and the variability in improvement of peak VO2.
Conclusion
Whereas VO2
max improves on LVAD support, but not significantly, it provides an adequate
functional capacity suitable for daily living activities. Yet, the link between peak VO2, everyday
tasks and quality of life requires further investigations in LVAD patients. Further studies should
focus towards identifying predictive factors associated with lack of improvement in VO2
max and
exertional capabilities in order to proceed with LVAD treatment concordant with patients’
values, objectives and expectations.