Ventricular reconditioning and pump explantation in patients supported by continuous-flow left ventricular assist devices

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Frazier, O. H.^1,2  Baldwin, Andrew C. W.^1,2  Demirozu, Zumrut T.^1,2  Segura, Ana Maria^1,2  Hernandez, Ruben^1,2  Taegtmeyer, Heinrich³  Mallidi, Hari^1,2  Cohn, William E.^1,2 

[1] Texas Heart Inst, Dept Cardiopulm Transplantat, Houston, TX 77025 USA

[2] Texas Heart Inst, Ctr Cardiac Support, Houston, TX 77025 USA

[3] Univ Texas Houston, Sch Med, Dept Internal Med, Div Cardiol, Houston, TX USA

关键词: heart failure;    left ventricular assist device (LVAD);    ventricular unloading;    ventricular recovery;    ventricular reconditioning;   

DOI  :  10.1016/j.healun.2014.09.015

来源: Elsevier

【 摘 要 】

BACKGROUND: The potential for myocardial reconditioning and device explantation after long-term continuous-flow left ventricular assist device (LVAD) support presents an opportunity to delay or avoid transplantation in select patients. METHODS: Thirty of 657 patients with end-stage heart failure supported with continuous-flow LVADs were assessed for device explantation. Each patient underwent an individualized process of weaning focused on principles of ventricular unloading, gradual reconditioning, and transition to medical therapy. RESULTS: After varying reconditioning periods, 27 patients (16 men, 11 women; age, 39 +/- 12 years) underwent LVAD explant, and 3 patients (2 men, 1 woman; age, 22 +/- 6 years) were evaluated for explantation but could not be weaned. The duration of LVAD support was 533 +/- 424 days (range, 42-1,937 days) for the explant cohort and 1,097 +/- 424 days (range, 643-1,483) for the non-explant cohort. The LV end-diastolic dimension, LV ejection fraction, systolic pulmonary artery pressure, cardiac output, and cardiac index in the explant cohort were significantly improved at explantation (all, p < 0.05). Two late deaths occurred after LVAD explantation despite satisfactory native cardiac function, and 1 patient required resumption of LVAD support 2.7 years after device removal. The remaining explant patients remain in New York Heart Association classes I to II with medical management alone (mean survival post-explant, 1,172 +/- 948 days). The 3 candidates who could not be weaned ultimately underwent transplantation. CONCLUSIONS: The potential for recovery of native LV function after long-term continuous-flow LVAD support should encourage a more aggressive approach to ventricular reconditioning with the goal of device explantation and a return to medical management, particularly in young patients with dilated cardiomyopathy. J Heart Lung Transplant 2015;34:766-772 (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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