Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure
Background —Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantati...
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| Published in | Circulation (New York, N.Y.) Vol. 98; no. 22; pp. 2383 - 2389 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
01.12.1998
American Heart Association, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 |
| DOI | 10.1161/01.CIR.98.22.2383 |
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| Abstract | Background
—Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation.
Methods and Results
—A retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, V̇
o
2
averaged 14.5±3.6 mL · kg
−1
· min
−1
; LVAD flow, 8.0±1.3 L/min; Fick cardiac output, 11.4±3.3 L/min; and pulmonary capillary wedge pressure, 13±4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak V̇
o
2
declined from 17.3±3.9 to 13.0±6.1 mL · kg
−1
· min
−1
. In one of these patients, the device was explanted.
Conclusions
—Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted. |
|---|---|
| AbstractList | Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation.
A retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, VO2 averaged 14.5+/-3.6 mL. kg-1. min-1; LVAD flow, 8.0+/-1.3 L/min; Fick cardiac output, 11.4+/-3.3 L/min; and pulmonary capillary wedge pressure, 13+/-4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak VO2 declined from 17.3+/-3.9 to 13.0+/-6.1 mL. kg-1. min-1. In one of these patients, the device was explanted.
Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted. Background —Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation. Methods and Results —A retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, V̇ o 2 averaged 14.5±3.6 mL · kg −1 · min −1 ; LVAD flow, 8.0±1.3 L/min; Fick cardiac output, 11.4±3.3 L/min; and pulmonary capillary wedge pressure, 13±4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak V̇ o 2 declined from 17.3±3.9 to 13.0±6.1 mL · kg −1 · min −1 . In one of these patients, the device was explanted. Conclusions —Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted. Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation.BACKGROUNDMechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation.A retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, VO2 averaged 14.5+/-3.6 mL. kg-1. min-1; LVAD flow, 8.0+/-1.3 L/min; Fick cardiac output, 11.4+/-3.3 L/min; and pulmonary capillary wedge pressure, 13+/-4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak VO2 declined from 17.3+/-3.9 to 13.0+/-6.1 mL. kg-1. min-1. In one of these patients, the device was explanted.METHODS AND RESULTSA retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, VO2 averaged 14.5+/-3.6 mL. kg-1. min-1; LVAD flow, 8.0+/-1.3 L/min; Fick cardiac output, 11.4+/-3.3 L/min; and pulmonary capillary wedge pressure, 13+/-4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak VO2 declined from 17.3+/-3.9 to 13.0+/-6.1 mL. kg-1. min-1. In one of these patients, the device was explanted.Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted.CONCLUSIONSSignificant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted. BACKGROUND: Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation. METHODS AND RESULTS: A retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, VO2 averaged 14.5+/-3.6 mL. kg-1. min-1; LVAD flow, 8.0+/-1.3 L/min; Fick cardiac output, 11.4+/-3.3 L/min; and pulmonary capillary wedge pressure, 13+/-4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak VO2 declined from 17.3+/-3.9 to 13.0+/-6.1 mL. kg-1. min-1. In one of these patients, the device was explanted. CONCLUSIONS: Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted. |
| Author | Mancini, Donna M. Levin, Howard Cordisco, Marie Elena Savin, Sergey Rose, Eric Catanese, Katharine Beniaminovitz, Ainat DiTullio, Marco Flannery, Margaret Oz, Mehmet |
| Author_xml | – sequence: 1 givenname: Donna M. surname: Mancini fullname: Mancini, Donna M. organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 2 givenname: Ainat surname: Beniaminovitz fullname: Beniaminovitz, Ainat organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 3 givenname: Howard surname: Levin fullname: Levin, Howard organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 4 givenname: Katharine surname: Catanese fullname: Catanese, Katharine organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 5 givenname: Margaret surname: Flannery fullname: Flannery, Margaret organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 6 givenname: Marco surname: DiTullio fullname: DiTullio, Marco organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 7 givenname: Sergey surname: Savin fullname: Savin, Sergey organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 8 givenname: Marie Elena surname: Cordisco fullname: Cordisco, Marie Elena organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 9 givenname: Eric surname: Rose fullname: Rose, Eric organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY – sequence: 10 givenname: Mehmet surname: Oz fullname: Oz, Mehmet organization: From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1611319$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/9832482$$D View this record in MEDLINE/PubMed |
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| Keywords | Human Heart failure Device Treatment efficiency Cardiocirculatory support Cardiovascular disease Implantation Left ventricle Chronic Treatment Follow up study Heart disease Hemodynamics Left ventricle performance |
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| References | e_1_3_2_15_2 e_1_3_2_8_2 e_1_3_2_16_2 (e_1_3_2_3_2) 1991; 102 e_1_3_2_7_2 e_1_3_2_17_2 e_1_3_2_6_2 e_1_3_2_18_2 (e_1_3_2_12_2) 1998; 17 e_1_3_2_20_2 e_1_3_2_10_2 (e_1_3_2_19_2) 1995; 1996 e_1_3_2_21_2 e_1_3_2_5_2 e_1_3_2_11_2 e_1_3_2_4_2 e_1_3_2_13_2 e_1_3_2_2_2 e_1_3_2_14_2 (e_1_3_2_1_2) 1996; 15 (e_1_3_2_9_2) 1998; 17 9832479 - Circulation. 1998 Dec 1;98(22):2367-9 |
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—Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support.... Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the... BACKGROUND: Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support.... |
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| SubjectTerms | Adolescent Adult Biological and medical sciences Cardiology. Vascular system Cardiomyopathy, Dilated - epidemiology Cardiomyopathy, Dilated - therapy Coronary Disease - epidemiology Coronary Disease - therapy Echocardiography, Doppler Exercise Test Female Heart Heart failure, cardiogenic pulmonary edema, cardiac enlargement Heart-Assist Devices Hemodynamics Humans Incidence Male Medical sciences Middle Aged Myocardium Prospective Studies Recovery of Function - physiology Retrospective Studies Treatment Outcome Ventricular Function, Left - physiology Ventricular Remodeling - physiology |
| Title | Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure |
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