title: Is bridge to recovery more likely with pulsatile left ventricular assist devices than with nonpulsatile-flow systems?
abstract: BACKGROUND
  Weaning from left ventricular assist devices (LVADs) after myocardial recovery in patients with idiopathic dilated cardiomyopathy is a clinical option. With the broad application of continuous-flow pumps, we observed a decrease in the numbers of possible LVAD explanations due to myocardial recovery in these particular patients. We investigated this phenomenon and its causes.
  
  
  METHODS
  Between July 1992 and December 2009, 387 patients (age, 0.1 to 82 years) with idiopathic dilated cardiomyopathy underwent LVAD implantation at our institution. Patients were divided into two groups depending on whether they were weaned from the LVAD (group A) or not (group B). Univariate and multivariate analyses were performed on 24 different factors with a possible influence on myocardial recovery.
  
  
  RESULTS
  In 34 patients, LVAD removal due to myocardial recovery was performed with long-term stable cardiac function (weaning rate, 8.8%). Patients with a pulsatile-flow LVAD had an almost threefold chance for myocardial recovery (odds ratio, 2.719; 95% confidence interval, 1.182 to 6.254) than patients who received continuous-flow devices. Younger patients had significantly higher recovery rates than older patients (odds ratio, 1.036; 95% confidence interval, 1.016 to 1.057).
  
  
  CONCLUSIONS
  Pulsatile-flow LVADs and young age were important factors for myocardial recovery in idiopathic dilated cardiomyopathy patients in our analysis. Further studies should investigate whether pulsatility in itself or the different degrees of left ventricular unloading by the two types of systems play a role in myocardial recovery.
authors: German Heart Institute Berlin, Berlin, Germany.
authors: Thomas
authors: T
authors: Krabatsch
authors: Martin
authors: M
authors: Schweiger
authors: Michael
authors: M
authors: Dandel
authors: Alexander
authors: A
authors: Stepanenko
authors: Thorsten
authors: T
authors: Drews
authors: Evgenij
authors: E
authors: Potapov
authors: Miralem
authors: M
authors: Pasic
authors: Yu-Guo
authors: YG
authors: Weng
authors: Michael
authors: M
authors: Huebler
authors: Roland
authors: R
authors: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D015908:Counterpulsation / Q000379:methods*; D020878:Device Removal; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011673:Pulsatile Flow; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology; D055815:Young Adult