Preoperative beta-blocker treatment is a key for deciding left ventricular assist device implantation strategy as a bridge to recovery

Abstract

To date, there have been few reports demonstrating preoperative predictors for left ventricular reverse remodeling (LVRR) after LV assist device (LVAD) implantation, especially among patients with dilated cardiomyopathy (DCM). We retrospectively analyzed 60 patients with stage D heart failure due to DCM who had received LVAD treatment [pulsatile flow (PF) type, 26; continuous flow type, 34]. Data were evaluated at 6 months or just before explantation of the LVAD. We defined "LV reverse remodeling" (LVRR) by the achievement of an LV ejection fraction (LVEF) of ≥ 35 % after 6 months of LVAD support or explantation of LVAD within 6 months. LVRR occurred in 16 of our patients (26.7 %). Uni/multivariate logistic regression analyses for LVRR demonstrated that of the preoperative variables evaluated, PF LVAD usage and insufficient preoperative β-blocker treatment were independent predictors for LVRR. Patients who accomplished LVRR had a better clinical course, including lower levels of aortic valve insufficiency and lower levels of plasma B-type natriuretic peptide. Of the six patients (10.0 %) in whom LVADs were eventually explanted, all had an LVEF of ≥ 35 % before explantation or at 6 months. Based on these results, we conclude that DCM patients with insufficient preoperative β-blocker treatment have a chance to achieve LVRR under LVAD support as a bridge to recovery.

Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction

“…Patients were censored at the time of cessation of TLV, such as at ventricular assist device implantation. The doses of any β-blockers were corrected as an equivalent dose of carvedilol, 19) and the doses of any angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker were corrected as an equivalent dose of enalapril. 19) Statistical analyses: All data are expressed as the mean ± SD unless otherwise indicated.…”

“…The doses of any β-blockers were corrected as an equivalent dose of carvedilol, 19) and the doses of any angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker were corrected as an equivalent dose of enalapril. 19) Statistical analyses: All data are expressed as the mean ± SD unless otherwise indicated. Continuous variables were compared using an unpaired Student's t-test or the Mann-Whitney U test, as appropriate.…”

Everolimus Attenuates Myocardial Hypertrophy and Improves Diastolic Function in Heart Transplant Recipients

“…The doses of β-blocker and angiotensin converting enzyme inhibitor (ACEI) were standardized as the equivalent dose of carvedilol and enalapril as appropriate, respectively. 26) Perioperative data including donor age, total ischemic time, cardiopulmonary bypass time, and total operation time were also obtained.…”

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

“…49) Among them, patients with a very low cumulative dose of β-blocker (less than 1.6 g of carvedilol-equivalent dose) were super-responders in terms of LVRR (LVEF ≥ 35% and/or explantation of LVAD within 6 months). 48,50) In contrast, patients who eventually received LVAD implantation despite preoperative sufficient β-blocker treatment are inevitably non-responders to β-blockers, and such patients rarely achieve LVRR even with unloading by LVAD. In animal models, prolonged sufficient LV unloading by LVAD without β-blocker treatment could not facilitate LVRR, but rather increased the ratio of the myocardial fibrotic area, myocardial apoptosis, and cardiac stiffness.…”

“…We have also demonstrated in a clinical setting that PF LVAD had an advantage over CF pumps in terms of LVRR. 18,48) Now is the era of CF LVAD, and PF devices have a number of drawbacks compared with CF devices in terms of higher morbidity and mortality rates.…”