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
ARTICLE HIGHLIGHTS
Research background

Recent studies suggest that left ventricular assist device (LVAD) implantation has not been associated with an improvement in pulmonary function tests. However, the improvement seen in post-LVAD pulmonary hemodynamics outweighs the observed decrease in spirometry.

Research motivation

The studies investigating these parameters are not expansive and the overall methodological quality of the studies available is low. Further inquiry into the effects of the LVAD implantation on pulmonary hemodynamics, objective pulmonary function testing and on the observed clinical outcomes is needed.

Research objectives

This meta-analysis aims to stratify the observed outcomes in studies assessing these parameters, in order to better understand the factors contributing to the changes seen on pulmonary function testing and the correlation with pulmonary hemodynamics.

Research methods

Our study literature search was performed on published data until December 2019, using PubMed, EMBASE, and Cochrane databases. After screening the studies 132 articles deemed relevant were reviewed. 128 articles were excluded based on our selection criteria. Four studies were analysed and included in this meta-analysis.

Research 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 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).

Research conclusions

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.

Research perspectives

The short term and long-term effects of LVAD on the pulmonary hemodynamics on and pulmonary function tests need to be expanded and are essential in order to better assess outcomes. The need for randomized control trials exists to identify confounding factors that may affect the outcomes seen in the studies analyzed. Also, further studies with extended follow-up are needed to assess the clinical outcomes of the changes seen on PFTs and hemodynamics.