Clinical myocardial recovery in advanced heart failure with long term left ventricular assist device support

A case of fulminant myocarditis with full recovery after a 38‐h sustained asystole

“…ECMO is the first treatment option for catastrophic myocarditis owing to low invasiveness, mobility for bedside implementation, and utility during cardiopulmonary resuscitation in cardiac arrests. 5,14 The concurrent use of devices such as VA-ECMO with IABP or Impella, rather than VA-ECMO alone, in patients with severe heart failure and cardiogenic shock may reduce the left ventricle load, minimize myocardial injury, and improve clinical outcomes. 15 In severe cardiac dysfunction, the aortic valve does not open even when circulation is adequately secured by retrograde perfusion with VA-ECMO, and left ventricular thrombosis is a concern.…”

Percutaneous Decommissioning 11 Years After Initial CF-LVAD Placement

“…Although no consensus exists regarding exact criteria for determining candidates for LVAD withdrawal, data published to date support screening with TTEs at baseline pump speed followed by more detailed testing using TTE, hemodynamic assessment with a pulmonary artery catheter, and cardiopulmonary exercise testing at baseline and minimal pump speed in explant candidates ( Figure 3 ). 3 , 4 , 5 Pump decommissioning remains a rare event in all-comers after LVAD implantation. A 2016 study of 13,454 LVAD patients from the Interagency Registry for Mechanically Assisted Circulatory Support found an explant rate of 0.9% and 3.1% at 1 and 3 years, respectively, but prospective protocols closely monitoring LVAD patients for myocardial recovery have been able to achieve explant rates as high as ∼50%.…”

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

“…Echocardiographic surveillance is mandatory during follow-up, and can be useful in estimating filling pressures ( 325 ). With limited evidence, it seems that optimization of HF medication may improve LV function, thereby reducing RV afterload and improving its function ( 326 ). In the setting of late RVF, de novo AR should be ruled out, and revision of the log files looking for a progressive increase in power for a similar flow can help in suspecting an outflow graft obstruction.…”