Myocardial recovery using ventricular assist devices: Prevalence, clinical characteristics, and outcomes

Marc A. Simon, Robert L. Kormos, Srinivas Murali, Pradeep Nair, Michael Heffernan, John Gorcsan, Stephen Winowich, Dennis M. McNamara

Research output: Contribution to journalArticle

138 Scopus citations

Abstract

Background - Ventricular assist devices (VADs) are important bridges to cardiac transplantation. VAD support may also function as a bridge to ventricular recovery (BTR); however, clinical predictors of recovery and long-term outcomes remain uncertain. We examined the prevalence, characteristics, and outcomes of BTR subjects in a large single center series. Methods and Results - We implanted VADs in 154 adults at the University of Pittsburgh from 1996 through 2003. Of these implants, 10 were BTR. This included 2/80 (2.5%) ischemic patients (supported 42 and 61 days, respectively). Both subjects had surgical revascularization, required perioperative left VAD support, and were alive and transplant-free at follow up (232 and 1319 days, respectively). A larger percentage of nonischemic patients underwent BTR (8/74, 11%; age 30±14; 88% female; left ventricular ejection fraction 18±6%; supported 112±76 days). Three had myocarditis, 4 had post-partum cardiomyopathy (PPCM), and 1 had idiopathic cardiomyopathy. Five received biventricular support. After explantation, ventricular function declined in 2 PPCM patients who then required transplantation. Ventricular recovery in the 6 nonischemic patients surviving transplant-free was maintained (left ventricular ejection fraction 54±5%; follow-up 1.5±0.9 years). Overall, 8 of 10 BTR patients are alive and free of transplant (follow-up 1.6±1.1 years). Conclusions - In a large single center series, BTR was evident in 11% of nonischemic patients, and the need for biventricular support did not preclude recovery. For most BTR subjects presenting with acute inflammatory cardiomyopathy, ventricular recovery was maintained long-term. VAD support as BTR should be considered in the care of acute myocarditis and PPCM.

Original languageEnglish
Pages (from-to)I32-I36
JournalCirculation
Volume112
Issue number9 SUPPL.
DOIs
StatePublished - Aug 30 2005
Externally publishedYes

Keywords

  • Cardiomyopathy
  • Heart failure
  • Heart-assist device
  • Myocarditis
  • Transplantation

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    Simon, M. A., Kormos, R. L., Murali, S., Nair, P., Heffernan, M., Gorcsan, J., Winowich, S., & McNamara, D. M. (2005). Myocardial recovery using ventricular assist devices: Prevalence, clinical characteristics, and outcomes. Circulation, 112(9 SUPPL.), I32-I36. https://doi.org/10.1161/CIRCULATIONAHA.104.524124