title: Young patients with nonischemic cardiomyopathy have higher likelihood of left ventricular recovery during left ventricular assist device support.
abstract: BACKGROUND
  Recovery of ventricular function during left ventricular assist device (LVAD) support allowing device explantation occurs infrequently. We explored the hypothesis that certain patient profiles are more likely to exhibit LV recovery during LVAD support.
  
  
  RESULTS
  A retrospective analysis of data from the HeartMate II bridge to transplant (BTT) and destination therapy (DT) trials was conducted, including 490 BTT, 600 DT, and 18 compassionate-use patients. Of the 1,108 patients, 20 (1.8%; 10 BTT, 10 DT) were explanted owing to LV recovery. The median age was 33 years, and 12 patients (60%) were <40 years of age. History of heart failure was <1 year for 11 patients (61%), and the primary etiology was nonischemic (90%). Of the patients with nonischemic etiologies and <1-year history of heart failure, 13% were explanted. Three patients required LVAD reimplantation; of the remaining 17, 16 remain alive. At follow-up (median 510 days), the mean ejection fraction was 42% (20%-67%) and the mean left ventricular end-diastolic diameter was 55 ± 8 mm. At the 2-year follow-up (n = 13), patients were New York Heart Association functional class I or II and overall survival rate was 85 ± 11%.
  
  
  CONCLUSIONS
  The results of this study suggest that LV recovery is most likely to occur in young patients (<40 years) with nonischemic cardiomyopathy of <1 year duration. Two-year postexplant survival was excellent.
authors.affiliation: Montefiore Medical Center, Bronx, New York, USA. dgoldste@montefiore.org
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: Simon
authors.initials: S
authors.lastname: Maybaum
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MacGillivray
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: Roberta
authors.initials: R
authors.lastname: Bogaev
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrar
authors.forename: O Howard
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult