Continuous Left Atrial Pressure Monitoring Improves Outcomes in Heartmate II Patients

Left atrial (LA) pressure is indicative of left ventricular(LV) function, LV preload and LV afterload. Current monitoring methods such as pulmonary artery lines give an indirect measurement of LV preload. We hypothesize that direct measurement of LV preload with a Codman Microsensor(off label) will facilitate more accurate fluid management and optimal ventricular assist device (VAD) settings, thereby improving outcomes after VAD implantation. Between 2/10-9/13, 98 patients underwent LVAD implantation (Heartmate II). 78.6%(77/98) had a Codman Microsensor placed in the LA for intra-op and post op monitoring(LA line group); 21.4%(21/98) had conventional monitoring (no LA line group). Indications for VAD in LA line and no LA line groups differed for bridge to transplantation 67.5%(52/77) v. 38.1%(8/21)(p<0.022), destination therapy 29.9%(23/77) v. 57.7%(12/21) (p<0.004), respectively. No differences were seen for bridge to recovery in LA line 1.3%(1/77) v. no LA line 4.8%(1/21), p<0.384. Prior VAD malfunction was seen in 1.3%(1/77) in LA line. Mean age was 54.1 yrs (+/-11.7). Median LV ejection fraction 15%(15, 20), pre VAD pulmonary capillary wedge pressure 23 mmHg (18,27), and baseline demographics were similar between groups, except mean body surface area in LA line 2.01(+/-.24)m2 v. no LA line 1.78(+/-.20)m2(p<0.001) and women in LA line 18.2%(14/77) v. 42.9%(9/21), p<0.038. Median perfusion time was shorter in LA line 106 mins (82,151) v. no LA line 154 mins (111, 190), p<0.005. The LA line group had significantly shorter median ventilation time 17 hrs (10, 88) v. 61 hrs (13,234)(p<0.033), initial ICU time 153 hrs (113, 253) v. 225 hrs (145, 356)(p<0.022), and total ICU time of 154 hrs(115,258) v. 221 hrs(162,385), p<0.019. Median post operative length of stay trended towards significance in LA line 22 days (16,39) v. no LA line 31 days (22,40), p<0.053. Overall operative mortality was 5.1%(5/98) and 3.9%(3/77) in LA line v. 9.5%(2/21) no LA line, p<0.291. LA pressure monitoring system using a Codman Microsensor offers safe, reliable and accurate monitoring for LV preload during and after LVAD implantation. We observed shorter ventilation time, ICU and hospital length of stay in continuously monitored patients compared to conventional monitoring. Continuous LA pressure monitoring technique may improve outcomes after LVAD placement.