Explantation of a mechanical assist device: assessment of myocardial recovery.
Reliable predictors of myocardial recovery post-mechanical assist device implantation are not well defined. We report the case of a 29-year-old woman with refractory congestive heart failure due to acute myocarditis of unknown etiology. The patient was supported with a HeartMate (Thoratec Corp., Woburn, MI) left ventricular assist device for 100 days showing improvement in clinical status. Hemodynamic monitoring, dobutamine stress echocardiography, and cardiopulmonary testing were performed to identify myocardial recovery. Improvements in myocardial reserve, hemodynamic parameters, and myocardial oxygen consumption were identified prior to explantation. The patient was successfully explanted. This case confirms that myocardial recovery is feasible with the use of a mechanical assist device. This article describes our current left ventricular assist device weaning protocol.
Delgado
Diego H
DH
Division of Cardiology and Heart Transplantation, Toronto General Hospital, Toronto, ON, Canada.
Rao
Vivek
V
Miriuka
Santiago G
SG
Al-Hesayen
Abdurrahman
A
McIver
Jane
J
Feindel
Christopher M
CM
Cusimano
Robert J
RJ
Ross
Heather J
HJ
D000328:Adult; D020878:Device Removal; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006334:Heart Function Tests; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*