Left ventricular remodeling and myocardial recovery on mechanical circulatory support.
BACKGROUND
Myocardial recovery after ventricular assist devices (VAD) is rare but appears more common in nonischemic cardiomyopathies (NICM). We sought to evaluate left ventricular (LV) end diastolic diameter (LVEDD) for predicting recovery after VAD.


RESULTS
NICM patients receiving long-term mechanical support between 1996 and 2008 were reviewed. Subjects were divided into 3 groups: mild, moderate, and severe dilation (Group A: LVEDD <6.0 cm [n = 22]; Group B: 6.0-7.0 cm [n = 32]; Group C: >7.0 cm [n = 48], respectively). Overall, recovery (successful explant without transplantation) occurred in 14 of 102 subjects (14%). Of these, 2 died and 2 required transplantation within 1 year. Recovery was more common in patients without LV dilation (Groups A/B/C = 32%/22%/0%, P < .001), as was sustained recovery (alive and transplant free 1 year after explant; A/B/C = 27%/10%/0%, P = .001). Of the recovery patients in Group A, 6/7 (86%) had sustained recovery versus 3/6 (50%) in Group B.


CONCLUSIONS
Recovery occurred in 32% of NICM patients without significant LV dilation at time of VAD, the majority of whom experienced significant sustained recovery. Recovery was not evident in those with severe LV dilation. Routine echocardiography at the time of implant may assist in targeting patients for recovery after VAD.
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, USA. simonma@upmc.edu
Marc A
MA
Simon
Brian A
BA
Primack
Jeffrey
J
Teuteberg
Robert L
RL
Kormos
Christian
C
Bermudez
Yoshiya
Y
Toyoda
Hemal
H
Shah
John
J
Gorcsan
Dennis M
DM
McNamara
D000328:Adult; D009202:Cardiomyopathies / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D020257:Ventricular Remodeling / Q000502:physiology*