Mechanical circulatory support for cardiac amyloidosis

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Transplantation Medicine

Background:

• Cardiac amyloidosis, caused by abnormal AL or ATTR amyloid protein deposition, frequently leads to heart failure.
• Heart failure in cardiac amyloidosis often necessitates heart transplantation (HTx).
• The efficacy of mechanical circulatory support (MCS) in managing cardiac amyloidosis remains unclear.

Purpose of the Study:

• To evaluate the use and outcomes of MCS in patients with cardiac amyloidosis.
• To present institutional experience with MCS as a bridge to HTx for cardiac amyloidosis.

Main Methods:

• A retrospective review of consecutive cardiac amyloidosis patients who received MCS between 2010 and 2018.
• Comparison of clinical characteristics and outcomes between the MCS-Amyloid group and a matched control group (MCS-No Amyloid) at a 2:1 ratio.
• Analysis of patient demographics, INTERMACS Profile, and survival rates.

Main Results:

• 11 patients with cardiac amyloidosis received durable MCS, primarily total artificial hearts (9) or paracorporeal biventricular assist devices (2).
• Within one year, 82% of the MCS-Amyloid group were transplanted, with 18% mortality.
• In the control group, 36% were transplanted, 46% died, and 18% remained on MCS at one year.

Conclusions:

• Durable biventricular MCS is a feasible treatment option for carefully selected patients with amyloid cardiomyopathy.
• MCS can provide acceptable outcomes as a bridge to heart transplantation in this patient population.
• This approach demonstrates potential for improving survival in advanced cardiac amyloidosis.