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Advanced practice providers' utilization of EUROMACS (european registry for patients with mechanical circulatory support) : single center experience

Session Poster Session 2

Speaker Ylenia Ann Quiaoit

Event : Heart Failure 2019

  • Topic : cardiovascular nursing and allied professions
  • Sub-topic : Cardiovascular Nursing and Allied Professions - Other
  • Session type : Poster Session

Authors : YA Quiaoit (Philadelphia,US), BL Lentz (Philadelphia,US), JL Lajoie (Philadelphia,US), MRM Molina (Philadelphia,US)

Authors:
YA Quiaoit1 , BL Lentz1 , JL Lajoie1 , MRM Molina1 , 1University of Pennsylvania - Philadelphia - United States of America ,

Citation:

Background: EUROMACS was recently validated as an early predictor for post Left Ventricular Assist Device (LVAD) mortality due to right ventricular failure (RVF). Post LVAD RVF has been reported to be between 4% and 50%; and RVF associated mortality was seen in 29% of patients receiving an LVAD.

 Purpose: The aim of this study is to describe advanced practice providers’ role and utilization of EUROMACS predictive scores in patients requiring RVAD post LVAD implantation.

 Methods:  We performed a retrospective analysis of 56 (out of 63) patients who underwent LVAD implantation January 1, 2017 to May 31, 2018. Descriptive statistical analysis of the 56 cases with complete pre and post LVAD hemodynamics and echocardiograms data was performed. Cases with incomplete data was excluded from the analysis.

Results:  Summary of demographics: 1.  LVAD group (n-49): 40 males, 9 females, 14, 23 were for bridge to transplant (BTT), 27 were for destination therapy (DT), 3 for bridge to recovery (BTR), & 3 for bridge to intent (BTI). 2. BIVAD group (n-7):  7 males, 5 for BTI, 2 DT.  All 56 patients were successfully implanted with LVAD. 12.5%(n-7) required RVAD support post implantation. 3.5% (n-2 /56) 30-days mortality rate post BiVAD implantation. Our analysis revealed that pre-LVAD, patients who required RVAD support (BIVAD group) had higher average RA ( 14.7 vs 11.8 for LVAD group) and PCWP30 vs 24.1 for LVAD group) ; required more inotropic (42% require 2 or more vs 4% for LVAD group) and mechanical support (71% had either ECMO, Impella orIABP pre implant vs. 16% LVAD group). Also, BiVAD group also had pre-LVAD echocardiogram noting moderate and severe RV dysfunction. In the post-operative phase, the BIVAD group also had higher average RA (13), PCWP (18), required 2 or more inotropic support (71%, n-5), and more RV dysfunction (moderate - severe RV dysfunction) on their post LVAD implant echocardiograms.

Conclusion/Implications: Advanced Practice Providers’ (APP) understanding and utilization of EUROMACS as predictive tool in early intervention of BiVAD vs early RVAD support is pivotal in decreasing mortality in the first 30 days. Moreover, the echo-Doppler 'profile' of moderate to severe RV dysfunction is prevalent in patient requiring BiVAD support and immediate RVAD early post LVAD implantation. Moreover, APPs correlation of invasive hemodynamic data with the echo-Doppler provides  a comprehensive assessment and a useful weaning  tool of inotropes, vasodilators, and diuretic management.

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