Persistence of Cheyne–Stokes Breathing After Left Ventricular Assist Device Implantation in Patients With Acutely Decompensated End-stage Heart Failure

Padeletti, Margherita; Henriquez, Aurelio; Mancini, Donna M.; Basner, Robert C.

doi:10.1016/j.healun.2007.04.009

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 26, Issue 7 , Pages 742-744, July 2007

Persistence of Cheyne–Stokes Breathing After Left Ventricular Assist Device Implantation in Patients With Acutely Decompensated End-stage Heart Failure

Margherita Padeletti, MD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, Florence, Italy
Aurelio Henriquez, RPSGT
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians & Surgeons, New York.
Donna M. Mancini, MD
- Division of Cardiology, Columbia University College of Physicians & Surgeons, New York
Robert C. Basner, MD
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians & Surgeons, New York.
- Reprint requests: Robert C. Basner, MD, Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians & Surgeons, 622 West 168th Street, New York, NY 10032. Telephone: 212-305-7591. Fax: 212-305-7072.

Received 14 December 2006; received in revised form 28 February 2007; accepted 13 April 2007.

Three patients, who were admitted for acute decompensation of end-stage congestive heart failure (CHF), underwent nocturnal polysomnography (PSG) before, and from 7 to 80 days after, left ventricular assist device (LVAD) implantation. Moderate to severe sleep-disordered breathing (SDB) was diagnosed in all 3 patients within 48 hours of admission, consisting predominantly of Cheyne–Stokes breathing (CSB) with central sleep apnea. After LVAD implantation, despite improved hemodynamics and end-organ function, the patients continued to have moderate or severe CSB, although there was decreased time in CSB in 2 of them. These data suggest that optimization of hemodynamics and end-organ function with LVAD implantation in patients with acutely decompensated heart failure does not acutely reverse the central mechanisms underlying the diathesis for this CSB in this setting, nor does it protect patients from the potential morbidity associated with such SDB when CSB and decompensated heart failure co-exist.