title: Left ventricular reverse remodeling with a continuous flow left ventricular assist device measured by left ventricular end-diastolic dimensions and severity of mitral regurgitation.
abstract: Pulsatile flow left ventricular assist devices (LVADs) maximally unload the left ventricle (LV), leading to reverse remodeling of the myopathic LV that manifests as decreased LV end-diastolic dimension (LVEDD) and decreased severity of mitral regurgitation (MR). There is a paucity of data, however, regarding the ability of continuous flow (CF) pumps to adequately decompress the LV to induce similar reverse remodeling. We sought to evaluate the effects of CF-LVADs on LV reverse remodeling. From March 2006 through July 2011, one hundred patients with chronic heart failure underwent implantation of CF-LVAD (93 HeartMate II LVADs and seven HeartWare LVADs) as bridge-to-transplant (n = 68) and destination therapies (n = 32). Echocardiograms and right heart catheterizations were reviewed preoperatively and at 1 and 6 months post-LVAD implantation. Mean age was 52.1 ± 12.1 years; etiology of heart failure was ischemic cardiomyopathy in 34 patients and nonischemic dilated cardiomyopathy in 66 patients. Median LVAD support time was 378.3 days; 371.5 days for patients who received bridge-to-transplant therapy and 422.2 days for patients who underwent destination therapy. Left ventricular end-diastolic dimension significantly decreased at 1 month post-LVAD implantation from 71.6 ± 12.4 to 58.3 ± 13.8 mm (p < 0.001). Severity of MR also significantly decreased from 76.0% of patients having moderate or severe MR preoperatively to 8.0% with moderate or severe MR at 1 month post-LVAD (p < 0.001). These reductions were maintained at 6 months. These data demonstrate the ability of a CF-LVAD to significantly decompress the LV, leading to significant reductions in LVEDD and severity of MR. This reverse remodeling was apparent in the early postoperative period and was sustained at 6 months. Further studies are warranted to investigate whether this correlates with clinical LV recovery.
authors.affiliation: Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA. jmorgan2@hfhs.org
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Raghav
authors.initials: R
authors.lastname: Murthy
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.forename: Cristina
authors.initials: C
authors.lastname: Tita
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology*; D012189:Retrospective Studies; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling