Long-term follow-up of thoratec ventricular assist device bridge-to-recovery patients successfully removed from support after recovery of ventricular function

Farrar, David J.; Holman, William R; McBride, Lawrence R.; Kormos, Robert L.; Icenogle, Timothy B.; Hendry, Paul; Moore, Christopher A.; Loisance, D; El‐Banayosy, Aly; Frazier, Howard O.

doi:10.1016/s1053-2498(01)00408-9

Cited by 213 publications

(122 citation statements)

References 20 publications

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“…The main complication of mechanical circulatory support in these patients is bleeding. As seen with other systems the DeBakey LVAD comes with a high incidence of bleeding [4,9], our results indicate no significant differences with previously reported figures [11].…”

Section: Discussionsupporting

confidence: 59%

“…Copeland and associates [2] performed the first bridging to HTx by mechanical support in 1985. Mortality of terminal heart failure being very high as disease progresses, HTx candidates die while waiting on long lists [3,4]. According to the recently published REMATCH study [3], the use of left ventricular assist devices (LVAD) resulted in more than twice the survival rate and an improved quality of life, in comparison to optimal medical management.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

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Objective: The MicroMed DeBakey left ventricular assist device (LVAD) axial blood flow pump was used as bridge to heart transplantation (HTx) in patients with terminal heart failure. The aim was to evaluate this novel mechanical circulatory support system in regard to overall outcome. Methods: Prospective study in 15 HTx candidates (mean age 40^7 years) with terminal heart failure and maximal medical treatment due to ischemic cardiomyopathy (CMP, n ¼ 5), dilated CMP ðn ¼ 3Þ, restrictive CMP ðn ¼ 2Þ, unclassified CMP ðn ¼ 1Þ, metabolic CMP ðn ¼ 1Þ, valvular CMP ðn ¼ 1Þ and congenital CMP ðn ¼ 2Þ. All patients were implanted with a MicroMed DeBakey LVAD. A rescue procedure was necessary in eight critical patients, while seven underwent elective LVAD implantation. Procedures were performed via median sternotomy, in normotherm femoro-femoral CPB (mean duration 59^1 min). Oral Marcoumar q (INR 2.0-3.0) and Aspirin q (100 mg daily) were started as soon as possible. Patients were discharged into a specialized rehabilitation clinic from which it was possible to release them home after a few weeks. Results: Successful implantation and discharge from ICU (mean stay 10^7 days) was possible in 11 patients. Seven were transplanted (mean support 50.7 days) and one is awaiting HTx (support .310 days) in the comfort of his home (NYHA I). Survival was 100% among the transplanted patients. Of the seven elective implants, five, and of the eight rescue procedures three patients underwent successful HTx. Four patients died early, while three patients died late on pump support due to intracranial hemorrhage (n ¼ 2, 73 and 76 days) and chest infection (n ¼ 1, 124 days). All survivors were discharged from hospital, with significant decrease in NYHA class (mean 3.8-2.4 ðn ¼ 11Þ). Treadmill testing showed increased exercise tolerance, from 35 to 71 W ðn ¼ 4Þ. Plasma BNP values (mean 950-162 ng/l ðn ¼ 4Þ) and pulmonary resistance (mean 316 -194.5 dyne s/cm 5 ðn ¼ 3Þ) decreased significantly during LVAD support. Conclusions: The MicroMed DeBakey LVAD is simple to implant; outpatient treatment is safe and efficient. Patients' condition and pulmonary resistances normalize within 6 weeks, making previously considered inoperable patients amenable for HTx. HTx can be performed in low-risk situation, allowing better donor -recipient matching and improving overall outcome. q

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Section: Discussionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

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“…Furthermore, many cellular processes improve, although they do not completely normalise. [5][6][7][8][9][10][11][12][13][14][15] Sufficient recovery of left ventricular function, allowing LVAD explantation, however, is rare and is mainly feasible in patients suffering from acute myocarditis or PPCM. 10,11,13 In these cases, the LVAD will maintain the patient's life, allowing the myocardium to recover from the underlying disease.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term results after explantation are favourable (one-and five-year survival rate of 86 and 78%, respectively). 14,15 In patients with longstanding idiopathic dilating cardiomyopathy, the concept of reverse remodelling while on the LVAD is intriguing but requires further study to see to what extent this may result in explantation of the device, to investigate the optimal drug regime necessary and the reliable monitoring of this process. 6-9 ■ …”

Section: Discussionmentioning

confidence: 99%

Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy

Oosterom¹,

Jonge²,

Kirkels³

et al. 2008

NHJL

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Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy Left ventricular assist devices (LVAD) are an effective therapeutic option for end-stage heart failure patients as a bridge to cardiac transplantation in those who deteriorate despite maximal therapy and when a donor heart is not ready available. In some patients, cardiac recovery has been reported while supported by an LVAD. In this case report, we describe a 29-year-old female who was admitted to our centre because of peripartum cardiomyopathy (PPCM). Despite intensive treatment with intravenous inotropes and intra-aortic balloon counterpulsation she had a persisting low cardiac index and an LVAD was implanted. In the months following implantation the left ventricular systolic function improved and the left ventricular dimensions normalised. Eventually the LVAD could be explanted nine months after implantation. At this moment, three years after explantation, echocardiography shows a normal-sized left ventricle and almost completely recovered systolic function. (Neth Heart J 2008;16:426-8).

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“…It is FDA approved as a bridge to transplant. In the seventh Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) report, only 1% of the 1357 patients with continuous flow left ventricular assist devices (CFLVADs) that were implanted with the bridge-to-transplant (BTT) strategy had sufficient myocardial recovery to allow explant of the LVAD at 12 months [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Effective Illustration of Decommissioning of Left Ventricular Assist Device after Bridge-to-Recovery by Hybrid Minimally-Invasive Tactic: Anesthesia Substances

Thay¹,

Shah²,

Kothandan³

2017

J Anesth Clin Res

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We report successful decommissioning of HeartWare left ventricular assist device (LVAD) (HVAD, HeartWare Inc., Framingham, MA) leaving the pump in situ by hybrid percutaneous approach. In this case, the indication for mechanical assist device separation was myocardial recovery, which occurred following 19 months of LVAD support.Anaesthetic goals include maintenance of sinus rhythm, avoidance of myocardial depression and increase in systemic vascular resistance (SVR), with optimal blood pressure control, normothermia, and judicious fluid management. Intraoperative assessment of suitability to wean using transesophageal echocardiography (TEE) and continuous cardiac output monitoring with pulmonary artery catheter must be expedient as no anticoagulation is given. This case report demonstrates the feasibility of separating a patient from a LVAD without the need for a major re-operative intervention.

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Long-term follow-up of thoratec ventricular assist device bridge-to-recovery patients successfully removed from support after recovery of ventricular function

Cited by 213 publications

References 20 publications

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy

Effective Illustration of Decommissioning of Left Ventricular Assist Device after Bridge-to-Recovery by Hybrid Minimally-Invasive Tactic: Anesthesia Substances

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