Predicting Fluid Responsiveness using Passive Leg Raising in the Early Postoperative Period after Left Ventricular Assist Device Implantation

Background: Left Ventricular Assist Device (LVAD) implantation is a common surgical procedure in patients with end-stage heart failure. Optimal fluid management is essential for adequate postoperative treatment. It is important to identify which patients will benefit from fluid administration. Passive leg raising (PLR) is a validated dynamic method to predict fluid responsiveness in patients with heart failure by inducing a transient increase in cardiac preload.

Objective: We perform prospective study to investigate the role of PLR on the management of patients following LVAD implantation in the postoperative period.

Methods: A prospective study was performed on 11 consecutive patients following LVAD implantation in whom five-minute PLR maneuvers were carried out during the first two hours after surgery (See Table). The LVAD flow as well as the central venous pressure (CVP) and mean arterial pressure (MAP) were measured before and after PLR. Fluid responsiveness was defined as at least 15% increase in the LVAD flow.

Results: Six patients were responders and five were non-responders for PLR. Four of the responders had RV dysfunction (≥3). Fluid responsiveness was associated with an increase of 0.59 L/min in the LVAD flow, the mean CVP raised from 10mmHg to 13.2mmHg and the MAP raised from 89.5mmHg to 92.5mmHg. The end tidal CO2 after the PLR in 4mm Hg in the responders group and in 1.8mmHg at the non-responders group.

Conclusion: PLR maneuver is a noninvasive and easy-to perform method to assess fluid responsiveness in patients after LVAD implantation, by using the LVAD flow monitor.