Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices.
BACKGROUND
Since our first successful left ventricular assist device (LVAD) explantation in a patient with idiopathic dilated cardiomyopathy (IDCM) in 1995, an additional 31 IDCM patients have been weaned in our department. Echocardiographic evaluations during repeated "off-pump" trials were the cornerstone for weaning decisions. After 9 years of experience, we assessed the reliability of our weaning criteria in light of the long-term results.


RESULTS
We evaluated all of the IDCM patients who were weaned between March 1995 and March 2004 with regard to preservation of cardiac function without LVAD support and survival after weaning. Additionally, we reviewed our echocardiographic data to assess their predictive value for long-term stability of cardiac function after weaning. The 32 weaned IDCM patients showed a survival rate of 78.3%+/-8.1 at 5 years after LVAD explantation. Heart failure (HF) recurred during the first 3 years after weaning in 31.3%. Only 2 patients died because of HF after weaning; the other patients with HF recurrence were successfully transplanted. Off-pump LV end-diastolic diameter >55 mm and/or LVEF <45% before LVAD removal, as well as history of HF > or =5 years before LVAD implantation, appeared to be major risk factors for early recurrence of HF. Patients without any of these 3 risk factors showed no HF recurrence during the first 3 years after weaning, but at the same time, all of those with at least 2 of these 3 risk factors developed early recurrence of HF. In patients with HF recurrence during the first 3 postweaning years, a significant LVEF decrease already occurred during the first month after weaning, whereas in those with long-term stable cardiac function even at the end of the sixth postweaning month, the LVEF was not different from that before LVAD removal.


CONCLUSIONS
For selected patients with IDCM, weaning from LVADs is a clinical option with good results over >9 years and should, therefore, be considered in those with cardiac recovery after LVAD implantation. Off-pump echocardiographic data are reliable for the detection of LV recovery and prediction of long-term cardiac stability after weaning.
Dandel
Michael
M
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. dandel@dhzb.de
Weng
Yuguo
Y
Siniawski
Henryk
H
Potapov
Evgenij
E
Lehmkuhl
Hans B
HB
Hetzer
Roland
R
D000328:Adult; D000818:Animals; D001323:Autoantibodies / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D020878:Device Removal; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D051381:Rats; D018342:Receptors, Adrenergic, beta-1 / Q000276:immunology; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left
D001323:Autoantibodies; D002317:Cardiovascular Agents; D018342:Receptors, Adrenergic, beta-1