PURPOSE: Pulmonary mechanics and gas transfer in congestive heart failure (CHF) patients are abnormal. LVEF is one of the independent factors that affects FEV1 besides age and smoking. Respiratory abnormalities such as airway obstruction, restrictive defects, and inspiratory muscle weakness are more pronounced in patients with severe CHF than in those with mild-to-moderate disease. Left ventricular assist device (LVAD) implation for severe CHF improves cardiac output and likely accounts for most of the improved exercise ability. The contribution of any improvements in lung function is not well understood and there is scant data about pulmonary function testing (PFT) in LVAD patients.
METHODS: We evaluated pre- and post-LVAD implantation PFTs to determine if LVADs improve the mixed ventilation and gas transfer disorders observed in CHF patients. We scanned our database of LVAD patients (169) looking for those who have PFTs performed before and after LVAD implantation and found four. Three of them had pre-LVAD PFTs performed at 139, 7 and 43 days before LVAD implantation and post-LVAD PFTs at 210, 285 and 795 days after LVAD, respectively. The fourth patient had PFTs preformed289 days before LVAD and 931 days post LVAD and is not included in the group analysis because of the long time differences.
RESULTS: We noted significant improvement (paired T-test) in FEV1 (p=0.007) and FVC (p=0.02) post VAD implantation in the first three patients though the FEV1/FVC ratio remained same. The TLC (p=0.08) and DLCO (p=0.051) also improved but did not reach statistical significance in our small group.
CONCLUSIONS: Our small retrospective study suggests that pulmonary mechanics and gas transfer may be improved post LVAD implantation and further studies are needed.
CLINICAL IMPLICATIONS: The knowledge gained from these studies may yield predictive information about the tolerability of the LVAD procedure and use, timing cardiac transplantation, and other important outcomes.
DISCLOSURE: The following authors have nothing to disclose: Muralidhar Kondapaneni, Usha Sadanala, Mark Slaughter, Rafael Perez
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