Clinical InvestigationLeft Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support
Section snippets
Study Design and Data Collection
Data from the University of Pittsburgh Medical Center Cardiothoracic Transplantation Program's Transplant Patient Management System was reviewed retrospectively. The Transplant Patient Management System is a password-protected, HIPAA-compliant, web-based prospective data collection for all patients who receive mechanical circulatory support and is approved by the University of Pittsburgh Institutional Review Board. Patients were included in the present study if they had a NICM and were
Results
Between 1996 and 2008, 348 patients underwent VAD implantation at the University of Pittsburgh for planned long-term support. Of these, 241 were excluded, largely because of an etiology of ischemic cardiomyopathy (Fig. 1). Of the remaining 107 VAD implants, 102 had LVEDD measured before implantation and were included in this analysis. There were 22 patients in Group A (LVEDD <6.0 cm), 32 patients in Group B (LVEDD 6.0 to 7.0 cm), and 48 patients in Group C (LVEDD >7.0 cm). Baseline
Discussion
Although myocardial recovery may remain an uncommon event among VAD-supported patients, this study demonstrated that for subjects with NICM and minimal remodeling, device explant for recovery occurred in 32%. For the majority of these subjects recovery was maintained with an event-free survival at 1 year of 86%. Recovery was also experienced in 22% of subjects with moderate LV dilatation, although the 1-year transplant-free survival in this cohort was only 50%. These findings suggest preimplant
Acknowledgments
The authors would like to thank Karen Janosko, MSN and Manuela Reali, MD for assistance with data collection; Don Severyn, MS, Steve Winowich, BSChE, Rick Schaub, PhD, for clinical bioengineering support; Kathleen Lockard, RN, Stephanie Weaver, RN, and Lori DeGore, RN, Eileen Stanford, RN, for clinical management; Michelle D. Navoney, BS, Darrick Mowrey, BA, and Julianne Buchanan, MS for Transplant Patient Management System data management.
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2019, Canadian Journal of CardiologyCitation Excerpt :This applies particularly when the stability of TTE measurements during and between the LVAD interruption trials (performed over the next 2 to 4 weeks after maximum LV improvement) is also considered (Table 2).21,24,26 A clinical profile that should encourage the consideration of elective LVAD explantation is that of shorter duration of HF, nonischemic etiology, younger patient age, and cardiac improvement within the first 6 months of LVAD support.4,5,16,21,22,46 In patients with normal RHC-derived off-pump hemodynamics before explantation, off-pump LVEF ≥ 45% at rest showed a predictive value of 74% for ≥ 5-years postexplant cardiac stability.24
Complications of Durable Left Ventricular Assist Device Therapy
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2016, Journal of the American College of CardiologyCitation Excerpt :Left ventricular unloading by mechanical support has the potential to disrupt the vicious cycle of volume and pressure overload leading to cardiac remodeling. Several studies have shown reverse remodeling in LVAD-supported patients, in some sufficient to allow for explantation of the device (17,18,22,35–40). These observations have opened the gateway to the field of LVAD-induced cardiac recovery.
Dr. Simon is supported by the NIH Roadmap Multidisciplinary Clinical Research Career Development Award (KL2 RR024154). Dr. McNamara is supported by NIH AwardR01 HL75038, and K24 HL069912. Dr. Primack is supported by a grant from the National Cancer Institute (K07-CA114315) and a grant from the Maurice Falk Foundation. Dr. Gorcsan is supported in part by NIH award K24 HL04503 and R01 HL086918. Dr. Kormos is on the medical advisory boards of Thoratec Corporation & World Heart Corporation. No other authors report relationships with industry.