The feasibility of left ventricular mechanical support as a bridge to cardiac recovery.
OBJECTIVE
To study the achievability of device weaning in patients receiving left ventricular assist devices (LVADs) as a bridge to transplantation.


METHODS
Eighteen consecutive patients receiving a LVAD between September 1997 and June 2002 were included in the study. During a four-month follow-up, patients were repeatedly evaluated with right heart catheterization and echocardiography and, if functional improvement was observed, studied with the device turned off. Cardiac recovery was defined as off-pump LVEF>or=40% together with a significant improvement in invasive haemodynamic measurements (CI>or=2.5 and PCWP<or=10-12 mm Hg). Patients fulfilling these criteria were considered for weaning.


RESULTS
Three patients fulfilled the predefined criteria for cardiac recovery and were subjected to device explantation. In one patient, a young female with acute myocarditis, the following course was uneventful. In the second patient, a male with dilated cardiomyopathy, heart failure reoccurred only a few days later. The third patient had a relapse of giant cell myocarditis and was transplanted. One patient underwent transplantation before follow-up evaluation could be performed.


CONCLUSIONS
In our experience, patients with severe advanced heart failure are unlikely to show significant cardiac recovery following treatment with LVAD, in contrast to previous suggestions.
Liden
Hans
H
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.
Karason
Kristjan
K
Bergh
Claes-Håkan
CH
Nilsson
Folke
F
Koul
Bansi
B
Wiklund
Lars
L
D000328:Adult; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology; D009205:Myocarditis / Q000150:complications / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome