Prediction of cardiac function after weaning from ventricular assist devices.
OBJECTIVE
We analyzed the factors influencing the cardiac function of patients after weaning from ventricular assist devices and established a prognostic index.


METHODS
A multivariate analysis was performed using the Cox proportional hazards model of the clinical parameters of 28 patients with end-stage heart failure before implantation of a ventricular assist device and directly before weaning from the device.


RESULTS
After weaning from the ventricular assist devices, 14 of the 28 investigated patients showed stable cardiac function, and 12 had recurrent heart failure, but only 1 of them died before transplantation or implantation of another ventricular assist device, and 2 patients died of causes unrelated to heart failure. In addition to left ventricular ejection fraction, the duration of symptomatic heart failure and left ventricular intracavitary dimensions in diastole measured before ventricular assist devices weaning were the major factors influencing cardiac function after weaning. In the group of patients with heart failure duration less than 3 years, only 2 of 13 cases were recurrent, but in the group with heart failure duration more than 3 years, 10 of 15 cases were recurrent. In 10 patients with 40 to 50 mm left ventricular intracavitary dimensions in diastole before weaning, only 1 case was recurrent. In 10 patients with 51 to 55 mm left ventricular intracavitary dimensions in diastole, 3 cases were recurrent. In the group with left ventricular intracavitary dimensions in diastole more than 56 mm, all 8 cases were recurrent. A prognostic index was calculated using the following formula: prognostic index = -10.10 + 0.208 (heart failure duration in years) + 0.173 (pre-explantation left ventricular intracavitary dimensions in diastole in millimeters). In the group with a prognostic index less than 0, only 2 of 16 cases were recurrent, and the rate of stable cardiac function in the 51st month after weaning was 83.6%. In the group with a prognostic index greater than 0, 10 of 12 cases were recurrent, and the rate of stable function in the 57th month was 0.0%.


CONCLUSIONS
In patients with off-pump left ventricular ejection fraction greater than 40%, the duration of symptomatic heart failure and the left ventricular intracavitary dimensions in diastole measured before weaning yield a useful index to predict long-term cardiac function after weaning from ventricular assist devices.
Liang
Hong
H
Department of Cardiothoracic Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China. lianghong58@hotmail.com
Lin
Hansheng
H
Weng
Yuguo
Y
Dandel
Michael
M
Hetzer
Roland
R
D020878:Device Removal; D005260:Female; D006321:Heart / Q000502:physiology*; D006333:Heart Failure / Q000601:surgery; D006334:Heart Function Tests; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis