© 2007 European Society of Cardiology
The feasibility of left ventricular mechanical support as a bridge to cardiac recovery
a Department of Cardiothoracic Surgery, Sahlgrenska University Hospital S-413 45 Gothenburg, Sweden
b Department of Cardiology, Sahlgrenska University Hospital Gothenburg, Sweden
c Department of Cardiothoracic Surgery, Lund University Hospital Lund, Sweden
* Corresponding author. Tel.: +46 31 3427502; fax: +46 31 417991. E-mail address: lars.wiklund{at}vgregion.se
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Abstract |
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Objective: To study the achievability of device weaning in patients receiving left ventricular assist devices (LVADs) as a bridge to transplantation.
Methods: Eighteen consecutive patients receiving a LVAD between September 1997 and June 2002 were included in the study. During a four-month follow-up, patients were repeatedly evaluated with right heart catheterization and echocardiography and, if functional improvement was observed, studied with the device turned off. Cardiac recovery was defined as off-pump LVEF
40% together with a significant improvement in invasive haemodynamic measurements (CI2.5 and PCWP
10–12 mm Hg). Patients fulfilling these criteria were considered for weaning.
Results: Three patients fulfilled the predefined criteria for cardiac recovery and were subjected to device explantation. In one patient, a young female with acute myocarditis, the following course was uneventful. In the second patient, a male with dilated cardiomyopathy, heart failure reoccurred only a few days later. The third patient had a relapse of giant cell myocarditis and was transplanted. One patient underwent transplantation before follow-up evaluation could be performed.
Conclusion: In our experience, patients with severe advanced heart failure are unlikely to show significant cardiac recovery following treatment with LVAD, in contrast to previous suggestions.
Key Words: Heart transplantation • Left ventricular assist device • Mechanical support • Recovery
Received October 4, 2006; Accepted December 4, 2006
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