Background: The predictive value of preoperative pulmonary function
testing (PFT) in left ventricular assist device (LVAD) patients remains
unknown. This study evaluates the relationship between abnormal PFTs and
postimplant outcomes in LVAD patients. Methods: LVAD implants from
January 2004 to December 2018 at a single institution were included.
Patients were stratified based on presence of abnormal preoperative
PFTs, and the primary outcome was respiratory adverse events (AE).
Secondary outcomes included one-year overall postimplant survival, and
complications including bleeding, renal failure, thromboembolism, and
device malfunction. Results: 333 patients underwent LVAD implant, 46.5%
(n=155) with normal PFTs and 53.5% (n=178) with abnormal PFTs. Patients
with abnormal PFTs were noted to have higher rates of respiratory AEs
(25.9% vs 15.1%, p=0.049). In multivariable analysis, the impact of
PFTs was most significant when FEV1/FVC ratio was <0.5 (HR
16.32, 95% CI 1.70, 156.78). The rates of other AEs including bleeding,
renal failure, right heart failure, and device malfunction were similar.
One-year overall postimplant survival was comparable between the groups
(56.8% vs 68.8%, p=0.3183), though patients in the lowest strata of
FEV1 (<60% predicted) and FEV1/FVC (<0.5) had
elevated risk-adjusted hazards for mortality (HR 2.63 95% CI 1.51, 4.60
and HR 18.92, 95% CI 2.10, 170.40, respectively). Conclusions: The
presence of abnormal preoperative PFTs is not prohibitory for LVAD
implantation although it can be used for risk stratification for
respiratory AEs and mortality, particularly in patients with severely
reduced metrics. The importance of careful patient selection should be
underscored in this higher risk patient subset.