Quality of Life After Removal of Left Ventricular Assist Device for Myocardial Recovery

George, Robert S.; Yacoub, Magdi H.; Bowles, Christopher; Hipkin, M.; Rogers, Paula; Hallas, Claire; Banner, Nicholas R.; Dreyfus, Gilles; Khaghani, Asghar; Birks, Emma J.

doi:10.1016/j.healun.2007.09.029

Cited by 57 publications

(60 citation statements)

References 20 publications

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“…24 Patients supported on an HM2 who recovered function and had the device explanted (BTR; nϭ14) had significantly better QOL and emotional health than patients who were supported on an HM2 and were transplanted (BTT; nϭ29) or were transplanted without LVAD support (transplantation; nϭ29). 25,26 Physical health was also higher in the BTR group than either the BTT or transplantation group but was not statistically significant. 25 It is important to note that the patients supported on an HM2 were on average 36 years of age, almost a decade younger than patients who participated in the HM2 LVAD clinical trials.…”

Section: Important Trendsmentioning

confidence: 77%

Quality of Life and Left Ventricular Assist Device Support

2012

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M ore than 5 million Americans are living with heart failure, with an additional 500 000 cases diagnosed each year. 1 Ongoing improvements in patient management will only increase the number of patients surviving to develop severe refractory heart failure (stage D). Approximately 5% to 10% of all heart failure patients are classified as stage D and defined as patients who continue to have symptoms of dyspnea or fatigue at rest despite optimal medical management. 2 Mechanical circulatory support (MCS) is an advanced surgical therapy for the treatment of stage D heart failure. 2 Last year, Ͼ1500 patients in the United States were implanted with a left ventricular assist device (LVAD), an implantable system that supports the failing left ventricle. 3 Implantation of an LVAD is an effective strategy to prolong survival and to improve the quality of life (QOL) of patients living with stage D heart failure. The indications for LVAD support include bridge to recovery (BTR), bridge to transplantation (BTT), or destination therapy (DT). The purpose of this article is to discuss QOL for patients supported on an LVAD. The discussion begins with an overview of QOL and how it is measured, followed by an in-depth review of QOL results in patients supported on an LVAD.

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Section: Important Trendsmentioning

confidence: 77%

Quality of Life and Left Ventricular Assist Device Support

2012

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“…This resulted in recovery sufficient to allow pump removal in around two thirds of patients with advanced DCM. Furthermore, these patients remained well 5 years later with good quality of life, 14 suggesting that this recovery was durable.…”

Section: Editorial See P 355 Clinical Perspective On P 390mentioning

confidence: 80%

Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy

et al. 2011

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Background-We have previously shown that a specific combination of drug therapy and left ventricular assist device unloading results in significant myocardial recovery, sufficient to allow pump removal, in two thirds of patients with dilated cardiomyopathy receiving a Heartmate I pulsatile device. However, this protocol has not been used with nonpulsatile devices. Methods and Results-We report the results of a prospective study of 20 patients who received a combination of angiotensin-converting enzymes, ␤-blockers, angiotensin II inhibitors, and aldosterone antagonists followed by the ␤ 2 -agonist clenbuterol and were regularly tested (echocardiograms, exercise tests, catheterizations) with the pump at low speed. Before left ventricular assist device insertion, patient age was 35.2Ϯ12.6 years (16 male patients), patients were on 2.0Ϯ0.9 inotropes, 7 (35%) had an intra-aortic balloon pump, 2 were hemofiltered, 2 were ventilated, 3 had a prior Levitronix device, and 1 had extracorporeal membrane oxygenation. Cardiac index was 1.39Ϯ0.43 L ⅐ min Ϫ1 ⅐ m Ϫ2 , pulmonary capillary wedge pressure was 31.5Ϯ5.7 mm Hg, and heart failure history was 3.4Ϯ3.5 years. One patient was lost to follow-up and died after 240 days of support. Of the remaining 19 patients, 12 (63.2%) were explanted after 286Ϯ97 days. Eight had symptomatic heart failure for Յ6 months and 4 for Ͼ6 months (48 to 132 months). Before explantation, at low flow for 15 minutes, ejection fraction was 70Ϯ7%, left ventricular end-diastolic diameter was 48.6Ϯ5.7 mm, left ventricular end-systolic diameter was 32.3Ϯ5.7 mm, mV O 2 was 21.6Ϯ4 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 , pulmonary capillary wedge pressure was 5.9Ϯ4.6 mm Hg, and cardiac index was 3.6Ϯ0.6 L ⅐ min Ϫ1 ⅐ m Ϫ2 . Estimated survival without heart failure recurrence was 83.3% at 1 and 3 years. After a 430.7Ϯ337.1-day follow-up, surviving explants had an ejection fraction of 58.1Ϯ13.8%, left ventricular end-diastolic diameter of 59.0Ϯ9.3 mm, left ventricular end-systolic diameter of 42.0Ϯ10.7 mm, and mV O 2 of 22.6Ϯ5.3 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 . Conclusions-Reversal of end-stage heart failure secondary to nonischemic cardiomyopathy can be achieved in a substantial proportion of patients with nonpulsatile flow through the use of a combination of mechanical and pharmacological therapy. (Circulation. 2011;123:381-390.)

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“…Pulmonary-capillary wedge pressure before explantation (with the device off for 15 min) was 9.0±4.1 mm Hg and cardiac index 2.8±0.7 l/m 2 . Interestingly, the same group demonstrated better results for quality of life in the bridge to recovery group 3.6 years after LVAD removal, compared to bridge to transplantation patients and even to transplanted patients (George et al, 2008). These impressive data proved that in carefully selected patients, long term, stable myocardial recovery can be achieved and this may be a legitimate treatment target for IDC patients requiring mechanical support, in order to improve not only their prognosis and quality of life but also donor organ allocation, particularly in the era of donor organ shortage.…”

Section: Evaluation Protocolsmentioning

confidence: 89%

“…This study was conducted using the firstgeneration, pulsatile HeartMate XVE device. Interestingly, the same group demonstrated better results for quality of life in the bridge to recovery group 3.6 years after the LVAD removal, compared to the bridge to transplantation patients and even to transplanted patients (George et al, 2008). Recently, the same investigators presented data supporting the feasibility of sustainable myocardial recovery using a continuous flow LVAD.…”

Section: Bridge To Recoverymentioning

confidence: 90%