SINGLE-CENTRE ANALYSIS OF LONG TERM EFFECTS OF CARDIAC SUPPORT DEVICES

Abstract

Heart failure affects more than 500000 patients in Canada with about 50000 new cases every year and average mortality of 10% per year. Left ventricular remodeling has a central role in development and progression of heart failure. Cardiac Support Devices (CSD) are surgically placed left ventricular diastolic restraint devices which have been studied for their ability to promote reverse remodeling and halt the progression of LV dilation. In this study, we present long-term follow-up for all patients at our institution who either received CSDs or were randomized to the control groups of CSD studies. We assessed NYHA Functional Status, adverse events, frequency of re-hospitalization, echocardiographic measures of reverse remodeling and intervention-free survival defined as sustaining 10 yr or more follow-up with a CSD without need for transplantation, repeat surgery, heart assistance or replacement devices. Using a retrospective cohort study design, we reviewed all patients who either had CSD implanted or were randomized to the control group within Acorn CorCap and Paracor device trials in our institution from January 2001-January 2015. A total of 10 patients (8 men and 2 women) were reviewed (7 CSD and 3 control) with mean follow-up of 8 years (SD 2.5 years). See table 1. Overall, having a CSD was associated with a trend towards better NYHA class (43% improved vs 0% in control), maintained EF (mean change in EF -0.3% vs -5% in control), lower LV mass index (mean change in LV mass index -16 gm vs +8 in control), more reduction in LVEDV(mean change in LVEDV -36 ml vs - 23 in control), and improved intervention-free survival. See figure 1. In our single-centre analysis of long-term outcomes in patients implanted with a CSD, there appears to be no adverse effects. Patients who received a CSD showed improved reverse remodeling and functional status, and were associated with a reduced need for re-hospitalization or re-intervention. More studies may be warranted to explore the value of CSDs as a therapeutic option in patients with advanced heart failure.View Large Image Figure ViewerDownload (PPT)