Left Ventricular Assist Devices as Bridge to Cardiac Recovery in Nonischemic Heart Failure: Keeping Weaning from the Device in Mind

Akil, Ali; Fischer, Dieter; Holthaus, Alexander J.; Martens, Sven; Scherer, M.; Sindermann, Jürgen R.

doi:10.1055/s-0035-1570374

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Si luego de la evaluación del paciente y de su función ventricular a bajo o mínimo soporte mecánico hay pruebas de significativo remodelado reverso miocárdico, estos paciente en terapia "puente a la recuperación" pueden ser considerados para el retiro de la asistencia 43 . Hay reportes de casos con exitosa explantación del dispositivo y recuperación completa de la fracción de eyección ventricular izquierda (FEVI) 44 . Birks et al 45 reportaron 70% de explantes del Heartmate VAD en una serie de 15 pacientes tratados con IECA, BB, ARA, espironolactona y clenbuterol.…”

Section: Ic Puente a La Recuperaciónunclassified

“…En este escaso porcentaje se observó explantación en el 50% de los casos, con una supervivencia a largo plazo de entre 25 y 30%. Varios estudios observacionales y registros han intentado buscar predictores clínicos, hemodinámicos, ecocardiográficos, neurohormonales, anatomopatológicos capaces de identificar aquellos pacientes que podrían presentar recuperación ventricular, sin encontrar ninguno significativo hasta el momento 44,46 . Las principales indicaciones para esta estrategia son: miocarditis aguda, fallo agudo primario del injerto postrasplante y miocardiopatía periparto, además del shock cardiogénico 1 .…”

Section: Ic Puente a La Recuperaciónunclassified

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Desafíos estratégicos en insuficiencia cardíaca avanzada. Asistencia ventricular: ¿está todo dicho?

Santillán¹

2018

RCON

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RESUMENLa insuficiencia cardíaca avanzada es la etapa final de múltiples enfermedades cardiovasculares y constituye en sí misma una de las patologías más prevalentes y con mayor morbimortalidad a nivel mundial. Se sabe que el tratamiento médico óptimo ha demostrado mejorar la sobrevida en términos de progresión de enfermedad y muerte súbita, así como el cardiodesfibrilador implantable y la terapia de resincronización cardíaca. A pesar de esto, un porcentaje no menor alcanza estadios avanzados en quienes el trasplante cardíaco puede ser una opción. Debido a las limitaciones actuales que esto implica, surgió el desarrollo de los dispositivos de asistencia ventricular (DAV). El propósito de esta monografía es revisar los aspectos clínicos y tecnológicos de los DAV. Se realizará un análisis de su evolución desde las primeras asistencias, se evaluarán indicaciones, el momento oportuno para su implante así como sus contraindicaciones. Posteriormente, se realizará una revisión de los aspectos a tener en cuenta por parte del médico tratante para la evaluación precolocación, considerando los scores de riesgo disponibles, los aspectos psicosociales y el costo/beneficio de su utilización, para así poder evaluar el impacto y la factibilidad de su aplicación en la práctica clínica diaria.Palabras clave: corazón auxiliar, insuficiencia cardíaca, trasplante de corazón. ABSTRACTAdvanced heart failure is the final stage of multiple cardiovascular diseases, constituting in itself one of the most prevalent pathologies and with the highest morbidity and mortality worldwide. It is known that optimal medical treatment has been shown to improve survival in terms of disease progression and sudden death, as well as the implantable cardioverter defibrillator and cardiac resynchronization therapy. Despite this, a non-minor percentage reaches advanced stages in whom heart transplantation may be an option. Due to the current limitations that this implies, the development of ventricular assist devices (VAD) arose. The purpose of this monograph is to review the clinical and technological aspects of VADs. An analysis of their evolution will be carried out from the first devices, indications will be evaluated, the opportune time for its implantation, as well as its contraindications. Subsequently, a review will be made on the aspects to be taken into account by the attending physician for the pre-placement evaluation, taking into account the risk scores available, psychosocial aspects and their cost / benefit; in order to evaluate the impact and feasibility of its application in daily clinical practice.

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Section: Ic Puente a La Recuperaciónunclassified

Desafíos estratégicos en insuficiencia cardíaca avanzada. Asistencia ventricular: ¿está todo dicho?

Santillán¹

2018

RCON

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Myocardial recovery in children supported with a durable ventricular assist device—a systematic review

Rohde

Bogers

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Introduction A small percentage of paediatric patients supported with a ventricular assist device (VAD) can have their device explanted following myocardial recovery. The aim of this systematic review is to summarize current literature on clinical course in these children after weaning. Methods A systematic literature search was performed on 27th of May, 2022 using Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar to include all literature on paediatric patients supported by a durable VAD of the last decade. Overlapping study cohorts and registry-based studies were filtered out. Results Thirty-seven articles were included. Eighteen of them reported on incidence of recovery in cohort studies, with an overall incidence rate of 8.7% (81/928). Twenty-two of the included articles reported on clinical outcomes after VAD explantation (83 patients). Aetiology varied widely and was not limited to diseases with a natural transient course like myocarditis. Most of the patients in the included studies (70; 84.3%) were supported by a Berlin Heart EXCOR™, and in 66.3% (55/83) only the left ventricle had to be supported. The longest follow-up was 19.1 years and multiple studies reported on long-term myocardial recovery. Less than half of the reported deaths had a cardiac cause. Conclusions Myocardial recovery during VAD support is dependent on various contributing components. The interaction between patient-, device-, time-, and hospital-related factors is complex and not yet fully understood. Long-term recovery after VAD support is achievable, even after a long duration of VAD support, and even in patients with aetiology different than myocarditis or post-cardiotomy heart failure. More research is needed on this favourable outcome after VAD support.

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A detailed explantation assessment protocol for patients with left ventricular assist devices with myocardial recovery

Vela

Bastón

Panoulas

et al. 2020

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Left ventricular assist device (LVAD) implantation for end-stage heart failure patients has been on the rise, providing a reliable long-term option. For some LVAD patients, longer term LV unloading leads to recovery; hence, the need for evaluating potential myocardial recovery and weaning eligibility has emerged. METHODS All patients who underwent contemporary LVAD explantation at our institution between 2009 and 2020 were included in the study. Patients in New York Heart Association I, left ventricular ejection fraction >40%, a cardiac index >2.4 l/min and a peak oxygen intake >50% predicted underwent a 4-phase weaning assessment. A minimally invasive approach using a titanium plug was the surgery of choice in the most recent explants. Kaplan–Meier curves were used to estimate the survival at 1 and 5 years. RESULTS Twenty-six patients (17 HeartMate II, 9 HeartWare) underwent LVAD explantation after a median 317 days of support [IQ (212–518)], range 131–1437. Mean age at explant was 35.8 ± 12.7 years and 85% were males. Idiopathic dilated cardiomyopathy was the underlying diagnosis in 70% of cases. Thirteen (48%) patients were on short-term mechanical circulatory support and 60% required intensive care unit admission prior to the LVAD implantation. At 1 year, Kaplan–Meier estimated survival was 88%, whereas at 6 years, it was 77%. The average left ventricular ejection fraction at 1 year post-explant was 44.25% ± 8.44. CONCLUSIONS The use of a standardized weaning protocol (echocardiographic and invasive) and a minimally invasive LVAD explant technique minimizes periprocedural complications and leads to good long-term device-free survival rates.

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Left Ventricular Assist Devices as Bridge to Cardiac Recovery in Nonischemic Heart Failure: Keeping Weaning from the Device in Mind

Cited by 4 publications

References 7 publications

Desafíos estratégicos en insuficiencia cardíaca avanzada. Asistencia ventricular: ¿está todo dicho?

Desafíos estratégicos en insuficiencia cardíaca avanzada. Asistencia ventricular: ¿está todo dicho?

Myocardial recovery in children supported with a durable ventricular assist device—a systematic review

A detailed explantation assessment protocol for patients with left ventricular assist devices with myocardial recovery

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