Tolvaptan is an effective
therapy for
heart failure patients with symptomatic congestion and
hyponatremia. The efficacy of its use in patients with continuous-flow left
ventricular assist devices (LVADs) is unknown. The aim of this study was to assess the clinical efficacy and safety of
tolvaptan in LVAD patients. We retrospectively reviewed medical records of patients who underwent LVAD implantation between January 2014 and August 2018. Among 217 consecutive LVAD patients,
tolvaptan was used in 20 patients. Mean age was 46 ± 14 years old and 14 patients were males. The duration of
tolvaptan therapy was 4 (interquartile range 1-8) days. Urine volume significantly increased from 2,623 ± 1,109 ml/day before
tolvaptan to 4,308 ± 1,432 ml/day during
tolvaptan therapy (p < 0.001). Serum
sodium increased from 127 ± 3 to 133 ± 3 mEq/L at the end of
tolvaptan therapy (p < 0.001). No patients developed
hypernatremia (serum
sodium >150 mEq/L). The 90-day overall survival following
tolvaptan therapy was 89% in both the
tolvaptan group and a propensity score-matched non-
tolvaptan group (p = 0.918). Survival free of
heart failure readmissions was also comparable between the groups (p = 0.751). In conclusion, short-term use of
tolvaptan following LVAD implantation is a safe and effective
therapy to augment diuresis and improve
hyponatremia.