Effects of Echo-optimization of Left Ventricular Assist Devices on Functional Capacity (VAFRACT)
Condition: Heart Failure
MeSH terms: Heart Failure
Study type: Interventional

Summary: 
      After the implantation of a left ventricular assist device (LVAD), many patients continue to
      experience exercise intolerance. LVAD echo guided optimization (EO) determines a more
      favorable hemodynamic profile and could provide an improvement on functional capacity (FC).
      VAFRACT is a prospective randomized trial to evaluate the additional benefit of an EO
      approach on FC, measured by cardiopulmonary exercise test (CPET), in LVAD optimization free
      population.
    

Detailed description: 
      The use of Left Ventricular Assist Devices (LVAD) is a viable therapeutic option to improve
      survival and quality of life of patients with advanced and refractory heart failure (HF).
      However, after the implantation of an LVAD, patients' functional capacity (FC) is still
      reduced with maximum oxygen uptake (VO2 peak) values calculated at the cardiopulmonary
      exercise test (CPET) ranging from 11 to 20 ml/kg/min. LVAD echo guided optimization (EO)
      determines a more favorable hemodynamic profile, in particular for the right ventricle, and
      could provide an improvement on FC. VAFRACT is a prospective randomized trial to evaluate the
      additional benefit of an EO approach on FC, measured by CPET in LVAD optimization free
      population.

      The optimal device speed is defined as the one that allows an intermittent aortic valve
      opening and a neutral position of the interventricular septum without increasing aortic or
      tricuspid regurgitation associated or not to a dilatation of the right ventricle (RV). In
      this condition it is reasonable to expect a more favorable hemodynamic profile for the RV and
      a better response in terms of functional capacity.

      Subjects studied are HF patients supported with a continuous-flow LVAD: HeartMate II
      (Thoratec Inc., Pleasanton, CA) and HeartMate 3 (HM 3, Abbott, North Chicago, IL). Patients
      are recruited from our Day Hospital of the Cardiac Surgery Department at the University
      Hospital of Verona.
    

Intervention name(s): echo-optimization
Intervention type(s): Device
Intervention description(s): LVAD echo-optimization consists of routine comprehensive transthoracic echocardiography at the baseline speed setting, followed by stepwise incremental adjustments to the LVAD speed (revolutions per minute: rpm), with collection of prespecified echocardiographic parameters at each new speed (eg, left ventricle end-diastolic diameter, interventricular septal position, aortic valve opening frequency/duration, tricuspid and/or mitral regurgitation severity). The optimal velocity is defined as the one that allows an intermittent aortic valve opening and a neutral position of the interventricular septum without increasing aortic or tricuspid regurgitation, associated or not to a dilatation of the right ventricle. The recommended speed range varies according to the indications given in the data sheet for each specific device.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: left ventricular assist device; echo-optimization; functional capacity; cardiopulmonary exercise test