Functional Recovery Post Left Ventricular Assist Device Implantation in INTERMACS Profile 1 Population

Purpose Left ventricular assist device (LVAD) have been demonstrated to improve functional capacity as measured by 6-minute walk test (6MWT) in patients with advanced heart failure. However, studies have not investigated functional recovery in patients with different Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile. Methods We conducted a retrospective review to assess the impact of LVAD therapy on functional recovery in 59 patients who underwent continuous-flow LVAD implantation as bridge to transplant or destination therapy, from 5 May 2009 to 9 February 2018, with minimum LVAD support of 90 days and a follow-up of at least 6 months. The third and sixth month 6MWT was performed following LVAD implant. Results There were 49 males and 10 females, age range 14 to 70 years (mean age 49). Based on the INTERMACS profile, there were 8.4% (5) at profile 4, 20% (12) at profile 2 while the majority was at profile 1 and 3 at 34% (20) and 37% (22) respectively. 55.5% from INTERMACS profile 1 were unable to perform the 6MWT at one month post LVAD implant. The median 6MWT distance at third month across all INTERMACS profiles was 365m. At sixth month, the median 6MWT distance in profile 1 was 469m, 423m in profile 2, 390m in profile 3 and 375m in profile 4. Statistically, there was a significant improvement in 6MWT from the third to sixth month for profile 1 with the median distance difference of 92m (interquartile range=56.8-143.3m) as compared to profile 2 at 44m (interquartile range=30.5-54.3m), and profile 3 at 31.5m (interquartile range=13.8-96.5m) with p =0.007 and p= 0.027 respectively. However, the comparison was not done between profile 1 and 4 due to the small cohort in profile 4. Conclusion In conclusion, this review showed that the 6MWT for patients in INTERMACS profile 1, the high risk population, might be similar at third month in comparison to other profiles but it has demonstrated the most significant improvement in functional recovery at sixth month post LVAD implant with the survival rate of 100% at year 1.