Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2020; 12(11): 550-558
Published online Nov 26, 2020. doi: 10.4330/wjc.v12.i11.550
Effects of left ventricular assist device on pulmonary functions and pulmonary hemodynamics: A meta-analysis
Waqas Ullah, Casey Meizinger, Zain Ali, Ankur Panchal, Rehan Saeed, Donald C Haas, Eduardo Rame
Waqas Ullah, Casey Meizinger, Zain Ali, Rehan Saeed, Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
Ankur Panchal, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States
Donald C Haas, Department of Cardiology, Abington Jefferson Health, Abington, PA 19001, United States
Eduardo Rame, Department of Cardiology, Thomas Jefferson University, Abington, PA 19001, United States
Author contributions: Ullah W contributed to conceptualization, analysis, and manuscript writing; Meizinger C contributed to manuscript writing and data collection; Ali Z contributrd to revision; Panchal A contributed to data curation; Saeed R contributed to editing; Haas DC and Rame E contributed to supervision.
Conflict-of-interest statement: The authors have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Waqas Ullah, MD, Doctor, Department of Internal Medicine, Abington Jefferson Health, 1200 Old York Road, Abington, PA 19001, United States. waqasullah.dr@gmail.com
Received: April 28, 2020
Peer-review started: April 28, 2020
First decision: July 5, 2020
Revised: July 18, 2020
Accepted: October 30, 2020
Article in press: October 30, 2020
Published online: November 26, 2020
Processing time: 211 Days and 16.5 Hours
Abstract
BACKGROUND

Given current evidence, the effect of left ventricular assist device (LVAD) implantation on pulmonary function tests remains controversial.

AIM

To better understand the factors contributing to the changes seen on pulmonary function testing and the correlation with pulmonary hemodynamics after LVAD implantation.

METHODS

Electronic databases were queried to identify relevant articles. The summary effect size was estimated as a difference of overall means and standard deviation on a random-effects model.

RESULTS

A total of four studies comprising 219 patients were included. The overall mean forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and diffusion lung capacity of carbon monoxide (DLCO) after LVAD implantation were significantly lower by 0.23 L (95%CI: 0.11-0.34, P = 00002), 0.18 L (95%CI: 0.03-0.34, P = 0.02), and 3.16 mmol/min (95%CI: 2.17-4.14, P < 0.00001), respectively. The net post-LVAD mean value of the cardiac index was significantly higher by 0.49 L/min/m2 (95%CI: 0.31-0.66, P < 0.00001) compared to pre-LVAD value. The pulmonary capillary wedge pressure and pulmonary vascular resistance were significantly reduced after LVAD implantation by 8.56 mmHg (95%CI: 3.78-13.35, P = 0.0004), and 0.83 Woods U (95%CI: 0.11-1.55, P = 0.02), respectively. There was no significant difference observed in the right atrial pressure after LVAD implantation (0.61 mmHg, 95%CI: -2.00 to 3.32, P = 0.65). Overall findings appear to be driven by studies using HeartMateII devices.

CONCLUSION

LVAD implantation might be associated with a significant reduction of the spirometric measures, including FEV1, FVC, and DLCO, and an overall improvement of pulmonary hemodynamics.

Keywords: Pulmonary function tests; Left ventricular assist device; Spirometry; Ventricular assist device

Core Tip: Left ventricular assist device (LVAD) implantation can cause worsening of forced expiratory volume in one second, forced vital capacity, and diffusion lung capacity of carbon monoxide in post-LVAD patients. However, the benefits of LVAD implantation outweigh its risks in the context of pulmonary hemodynamics. More large scale studies are required to validate our findings.