Abstract
Background: Few patients with a left ventricular assist device (LVAD) achieve functional myocardial recovery to the point of LVAD explantation. The aim of this study was to highlight some of the hemodynamic and echocardiographic parameters we observed in patients who recovered.Methods: We conducted a retrospective analysis of 7 patients who received the HeartMate II LVAD (Abbott) at Temple Heart and Vascular Institute and subsequently underwent successful explantation following myocardial recovery. We compared baseline characteristics, echocardiographic data, and hemodynamic data.Results: Baseline characteristics of the cohort were as follows: age 51.6 ± 12.0 years, 57.1% male, 42.9% with nonischemic cardiomyopathy, and mean duration of LVAD support of 10.6 months. Comparison of echocardiographic and hemodynamic data (preimplant vs preexplant) revealed the following: left ventricular ejection fraction (%) was 12.8 ± 6.9 vs 52.8 ± 8.1 (P=0.0001), right atrial pressure (mmHg) was 12.3 ± 3.4 vs 5.0 ± 4.0 (P=0.022), mean pulmonary artery pressure (mmHg) was 36.0 ± 7.8 vs 15.4 ± 7.1 (P=0.01), cardiac output (L/min) was 3.6 ± 1.3 vs 5.5 ± 1.8 (P=0.004), and cardiac index (L/min/m2) was 1.8 ± 0.5 vs 2.7 ± 0.7 (P=0.008). Mean LVAD-free survival was 49.1 months. Results were consistent in both ischemic and nonischemic LVAD explants.Conclusion: A potential for LVAD explantation exists in patients with both ischemic and nonischemic cardiomyopathy. Myocardial recovery may be more likely among young patients with nonischemic cardiomyopathy and patients with recently diagnosed ischemic cardiomyopathy. Future prospective studies are needed.
Highlights
Heart failure affects nearly 6 million Americans,[1] is the leading cause of death globally for both men and women, and contributes to approximately 0.3 million deaths per year
Heart transplant is the gold standard for advanced heart failure, but because of the limited number of donor organs, left ventricular assist device (LVAD) therapy plays a major role as a bridge to transplant as well as destination therapy for patients who are not candidates for transplant
Our experience with LVAD explant shows that myocardial recovery is possible in patients with both ischemic and nonischemic cardiomyopathy
Summary
Heart failure affects nearly 6 million Americans,[1] is the leading cause of death globally for both men and women, and contributes to approximately 0.3 million deaths per year. Heart transplant is associated with complications: a lifelong need for immunosuppression to prevent cardiac allograft rejection, risk of infection, vasculopathy, and organ dysfunction.[4]. Together, these limitations have stimulated research into the feasibility of LVADs as a bridge to structural remodeling and recovery. Few patients with a left ventricular assist device (LVAD) achieve functional myocardial recovery to the point of LVAD explantation. Results: Baseline characteristics of the cohort were as follows: age 51.6 ± 12.0 years, 57.1% male, 42.9% with nonischemic cardiomyopathy, and mean duration of LVAD support of 10.6 months.
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