Myocardial recovery using ventricular assist devices: prevalence, clinical characteristics, and outcomes.

Abstract

BACKGROUND:

Ventricular assist devices (VADs) are important bridges to cardiac transplantation. VAD support may also function as a bridge to ventricular recovery (BTR); however, clinical predictors of recovery and long-term outcomes remain uncertain. We examined the prevalence, characteristics, and outcomes of BTR subjects in a large single center series.

METHODS AND RESULTS:

We implanted VADs in 154 adults at the University of Pittsburgh from 1996 through 2003. Of these implants, 10 were BTR. This included 2/80 (2.5%) ischemic patients (supported 42 and 61 days, respectively). Both subjects had surgical revascularization, required perioperative left VAD support, and were alive and transplant-free at follow up (232 and 1319 days, respectively). A larger percentage of nonischemic patients underwent BTR (8/74, 11%; age 30+/-14; 88% female; left ventricular ejection fraction 18+/-6%; supported 112+/-76 days). Three had myocarditis, 4 had post-partum cardiomyopathy (PPCM), and 1 had idiopathic cardiomyopathy. Five received biventricular support. After explantation, ventricular function declined in 2 PPCM patients who then required transplantation. Ventricular recovery in the 6 nonischemic patients surviving transplant-free was maintained (left ventricular ejection fraction 54+/-5%; follow-up 1.5+/-0.9 years). Overall, 8 of 10 BTR patients are alive and free of transplant (follow-up 1.6+/-1.1 years).

CONCLUSIONS:

In a large single center series, BTR was evident in 11% of nonischemic patients, and the need for biventricular support did not preclude recovery. For most BTR subjects presenting with acute inflammatory cardiomyopathy, ventricular recovery was maintained long-term. VAD support as BTR should be considered in the care of acute myocarditis and PPCM.

• Authors: Marc A Simon, Robert L Kormos, Srinivas Murali, Pradeep Nair, Michael Heffernan, John Gorcsan, Stephen Winowich, Dennis M McNamara
• Journal: Circulation (Circulation) Vol. 112 Issue 9 Suppl Pg. I32-6 (Aug 30 2005) ISSN: 1524-4539 [Electronic] United States
• PMID: 16159839 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Aspartate Aminotransferases
• Alanine Transaminase

Topics

• Acute Disease
• Adult
• Aged
• Alanine Transaminase (blood)
• Aspartate Aminotransferases (blood)
• Cohort Studies
• Female
• Follow-Up Studies
• Heart Failure (etiology, surgery)
• Heart-Assist Devices
• Humans
• Intra-Aortic Balloon Pumping
• Liver (enzymology, physiopathology)
• Liver Circulation
• Male
• Middle Aged
• Myocardial Infarction (complications, surgery)
• Myocarditis (complications)
• Oxygen Consumption
• Postoperative Complications (etiology, therapy)
• Retrospective Studies
• Stroke Volume
• Treatment Outcome