The online version of this article (doi:10.1186/1749-8090-9-93) contains supplementary material, which is available to authorized users.
Daniele Camboni, Tobias J Lange contributed equally to this work.
The authors declare that they have no competing interests.
DC, data collection, exercise testing, and presentation of the data as text and writing. TJL, data collection, exercise testing and presentation of the data as text and writing. PG, Data aqusition, Echocardiography, patient care, proof reading of the manuscript. SH, patient care, helped to draft the manuscript. BF, Echocardiography, patient care, proof reading of the manuscript. YZ, Anesthesia, helped to draft the manuscript. LR, Implanting surgeon, patient care, helped to draft the manuscript. MH, Implanting surgeon, patient care, helped to draft the manuscript. CS, Implanting surgeon, patient care, participated in the design of the study, helped to draft the manuscript, correction of the manuscript, comments to the reviewers. All authors read and approved the final manuscript.
LVAD speed adjustment according to a functioning aortic valve has hypothetic advantages but could lead to submaximal support. The consequences of an open aortic valve policy on exercise capacity and hemodynamics have not yet been investigated systematically.
Ambulatory patients under LVAD support (INCOR®, Berlin Heart, mean support time 465 ± 257 days, average flow 4.0 ± 0.3 L/min) adjusted to maintain a near normal aortic valve function underwent maximal cardiopulmonary exercise testing (CPET) and right heart catheterization (RHC) at rest and during constant work rate exercise (20 Watt).
Although patients (n = 8, mean age 45 ± 13 years) were in NYHA class 2, maximum work-load and peak oxygen uptake on CPET were markedly reduced with 69 ± 13 Watts (35% predicted) and 12 ± 2 mL/min/kg (38% predicted), respectively. All patients showed a typical cardiac limitation pattern and severe ventilatory inefficiency with a slope of ventilation to carbon dioxide output of 42 ± 12. On RHC, patients showed an exercise-induced increase of mean pulmonary artery pressure (from 16 ± 2.4 to 27 ± 2.8 mmHg, p < 0.001), pulmonary artery wedge pressure (from 9 ± 3.3 to 17 ± 5.3 mmHg, p = 0.01), and cardiac output (from 4.7 ± 0.5 to 6.2 ± 1.0 L/min, p = 0.008) with a corresponding slight increase of pulmonary vascular resistance (from 117 ± 35.4 to 125 ± 35.1 dyn*sec*cm−5, p = 0.58) and a decrease of mixed venous oxygen saturation (from 58 ± 6 to 32 ± 9%, p < 0.001).
An open aortic valve strategy leads to impaired exercise capacity and hemodynamics, which is not reflected by NYHA-class. Unknown compensatory mechanisms can be suspected. Further studies comparing higher vs. lower support are needed for optimization of LVAD adjustment strategies.
Authors’ original file for figure 113019_2014_1487_MOESM1_ESM.tif
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- Left ventricular support adjustment to aortic valve opening with analysis of exercise capacity
Tobias J Lange
- BioMed Central
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