Role of ventricular assist therapy for patients with heart failure and restrictive physiology: Improving outcomes for a lethal disease.
BACKGROUND
Restrictive cardiomyopathy (RCM) patients have poor prognosis due to progressive heart failure characterized by impaired ventricular filling of either or both ventricles. The goal of this study was to evaluate the outcome of end-stage RCM patients after left ventricular assist device (LVAD) implantation and to determine factors that may be associated with improved survival.


METHODS
This investigation is a retrospective study of prospectively collected data that include 28 consecutive patients with end-stage RCM who received continuous-flow LVADs at the Mayo Clinic, Rochester, Minnesota. Outcome was assessed by survival with LVAD support until heart transplantation or all-cause mortality.


RESULTS
The mean follow-up time post-LVAD implantation was 448 ± 425 days. The mean hospitalization time was 29 ± 19 days and was complicated mainly by post-operative right ventricular (RV) failure requiring short-term medical support. The short-term in-hospital mortality was 14%. Ten patients underwent heart transplantation with 100% survival post-transplant during the follow-up period. One-year survival for patients with LVADs without transplantation was 64%, and was not significantly different between amyloidosis and non-amyloidosis patients. Larger left ventricle (LV) end-diastolic and end-systolic dimensions were significantly associated with improved survival rates (RR = 0.94 and 0.95, p < 0.05, respectively), and left ventricular end-diastolic diameter (LVEDD) ≤46 mm was associated with increased mortality post-LVAD implantation.


CONCLUSIONS
LVAD is a feasible, life-saving therapy for end-stage heart failure related to RCM, especially as a bridge to transplant and in patients with larger LV dimensions.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Avishay
A
Grupper
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Soon J
SJ
Park
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Naveen L
NL
Pereira
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Sarah D
SD
Schettle
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Yariv
Y
Gerber
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Yan
Y
Topilsky
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Brooks S
BS
Edwards
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Richard C
RC
Daly
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
John M
JM
Stulak
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Lyle D
LD
Joyce
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: kushwaha.sudhir@mayo.edu.
Sudhir S
SS
Kushwaha
D000328:Adult; D000368:Aged; D002313:Cardiomyopathy, Restrictive / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
outcome; restrictive cardiomyopathy; transplantation; ventricular assist device