Predictive Value of Vasodilator Challenge for Right Heart Failure After LVAD Implantation

Study Overview
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Brief Summary
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Prospective evaluation of the predictive value for post-LVAD right ventricular failure (RHF) of pulmonary vasodilator challenge, in addition to current laboratory, echocardiographic and haemodynamic parameters. LVAD candidates satisfying the inclusion criteria will undergo vasodilator challenge with sodium nitroprusside (NTP) infusion following the study protocol. Thereafter, we will evaluate all data in order to determine which variables significantly correlate with RHF onset after LVAD implantation.

Detailed Description
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Inclusion criteria Age over 18 years old. Diagnosis of advanced heart failure with an indication for LVAD implantation. Mean Arterial Pressure (MAP) > 60 mmHg; Mean Pulmonary Arterial Pressure (mPAP) > 20 mmHg; Pulmonary Artery Wedge Pressure >15 mmHg. Vasodilator Challenge performed through NTP infusion. Exclusion criteria State of pregnancy. Inability to perform vasodilator challenge Need for extracorporeal membrane oxygenator or short-term right ventricular assist devices. Planned right ventricular assist device implantation in the peri-procedural setting. Right heart catheterization (RHC) RHC will be performed under optimal medical therapy within 90 days before LVAD implantation. Vasodilator challenge will be performed through intravenous nitroprusside administration and titration (by 5 minutes intervals) until symptoms (flushing or hypotension) onset or systolic systemic pressure drops below 85 mmHg. Dobutamine or phosphodiesterase inhibitors infusion could be performed at clinician's discretion. All haemodynamic measurements will be repeated after nitroprusside infusion and titration. Right heart failure (RHF) Post-operative RHF will be evaluated according to the definition proposed by the 2020 consensus statement of the mechanical circulatory support academic research consortium (1).

Official Title
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Predictive Value of Vasodilator Challenge for Right Heart Failure (RHF) After Left Ventricular Assist Device (LVAD) Implantation

Conditions
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Right Heart Failure

Intervention / Treatment
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* Drug: Pulmonary Vasodilators


Participation Criteria
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Eligibility Criteria
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Inclusion criteria Age over 18 years old. Diagnosis of advanced heart failure with an indication for LVAD implantation. Mean Arterial Pressure (MAP) > 60 mmHg; Mean Pulmonary Arterial Pressure (mPAP) > 20 mmHg; Pulmonary Artery Wedge Pressure >15 mmHg. Vasodilator Challenge performed through NTP infusion. Exclusion criteria State of pregnancy. Inability to perform vasodilator challenge Need for extracorporeal membrane oxygenator or short-term right ventricular assist devices. Planned right ventricular assist device implantation in the peri-procedural setting.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Enrolled patients - LVAD candidates<br>Inclusion criteria Age over 18 years old. Diagnosis of advanced heart failure with an indication for LVAD implantation. Mean Arterial Pressure (MAP) > 60 mmHg; Mean Pulmonary Arterial Pressure (mPAP) > 20 mmHg; Pulmonary Artery Wedge Pressure >15 mmHg. Vasodilator Challenge performed through NTP infusion. Exclusion criteria State of pregnancy. Inability to perform vasodilator challenge Need for extracorporeal membrane oxygenator or short-term right ventricular assist devices. Planned right ventricular assist device implantation in the peri-procedural setting. | Drug: Pulmonary Vasodilators<br>* Right heart catheterization via Swan Ganz catether will be performed under optimal medical therapy within 90 days before LVAD implantation. We will record the timing between RHC and LVAD implantation. Vasodilator challenge will be performed through intravenous nitroprusside administration and titration (by 5 minutes intervals) until symptoms (flushing or hypotension) onset or systolic systemic pressure drop below 85 mmHg (target dose). Dobutamine or phosphodiesterase inhibitors infusion could be performed at clinician's discretion. All haemodynamic measurements will be repeated after nitroprusside infusion and titration until the target dose.<br>* Other names: Vasodilator Challenge;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Endpoint | Early right heart failure | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Secondary Endpoint | In-hospital all-cause mortality | 24 months | 
| Secondary Endpoint | 1-year all-cause mortality; | 24 months | 
| Secondary Endpoint | Late right heart failure | 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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LVAD, Right Heart Failure, Advanced Heart Failure, Nitroprusside, Right Heart Catheterization