VENTRICULAR FUNCTION DURING VAD SUPPORT AS A BRIDGE TO RECOVERY

Abstract

The purpose of this study was to retrospectively evaluate measurements of ventricular function during VAD support in patients (pts) weaned from the device without transplantation. Twenty-two pts in cardiogenic shock, diagnosed with myocarditis (12), cardiomyopathy (7) or both (3), and without previous cardiac operations, were implanted with Thoratec VADs at 14 centers. Thirteen pts (59%) received BiVAD support, 9 (41%) received a LVAD, with 55% of VAD implants performed emergently. VAD duration was 57 ± 46 days. Before VAD removal, 17/18 pts had LVEF by echo >35% with VAD support at reduced levels or turned off. The highest LVEF during VAD support ranged from 32%–70% (mean, 49%). LV and RV size were considered normal or mildly enlarged in 15/15 pts and 14/15 pts, respectively. RV function was normal or mildly dysfunctional in 9/13 pts. At VAD explant, two pts were on low dose inotropic support, and renal and hepatic function had normalized in most pts. After VAD removal, 95% (21/22) were discharged alive. Mean follow-up post-explant is 2.2 years (range 0.3–9.8 yrs). Two-year actuarial survival is 80%. Conclusion: Patients demonstrating return of acceptable cardiac function and chamber size during VAD support can avoid transplantation and achieve acceptable long-term survival.