Left Ventricular Assist Device is a Viable Therapy in End Stage Hypertrophic Cardiomyopathy

Abstract


 
 
 Left Ventricular Assist Device (LVAD) therapy use is increasing rapidly in advanced heart failure (HF). Little data exists on the application of this therapy in patients with advanced HF due to hypertrophic cardiomyopathy (HCM). Altered ventricular geometry, thickened septum and reduced LV end-diastolic diameter (LVEDD) in HCM may lead to increased suction events, arrhythmias and inflow cannula malfunction. We hypothesized that patients with end stage HCM benefit from LVAD therapy and have a similar rate of complications to those with ischemic or dilated CM. Between 2009 and 2014, 5 patients with end stage HCM (HCM and EF <50%), were implanted with either a HeartMate II ® (80%) or HVAD® (20%) device, as a bridge-to-transplant (BTT) (80%) or destination therapy (DT) (20%). We compared baseline characteristics, surgical, and long-term clinical outcomes between these patients and those receiving an LVAD for end stage dilated and ischemic CM (n=214) during that time frame. The HCM cohort had a smaller LVEDD (5.2 versus 6.9 cm, p=0.001) and a higher LVEF (28% v 18%, p=0.002). Cardiopulmonary bypass time was similar between the groups (72min vs 69min). Post-operative length of stay was also similar at 21 days. Operative mortality for HCM patients was 0. All 4 BTT patients survived to transplant. LVAD therapy resulted in improved LVEDD (5.2 cm to 3.9 cm), PASP (58.8 mmHg to 30.8 mmHg), and cardiac index (1.5 to 2.82L/min/m2) in patients with HCM, without an increased incidence of postoperative complications. Median duration of LVAD support in the HCM group was 14 months and 10 months for the control.
 
 
 
 We conclude that select patients with end stage HCM may benefit from LVAD therapy with a similar rate of complications compared to traditional candidates. Additional study is warranted to further evaluate durable mechanical support in this population.