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Recovery of cardiac function by long-term left ventricular support in patients with end-stage cardiomyopathy
T Nakatani1, Y Sasako, J Kobayashi
1National Cardiovascular Center Hospital, Department of Cardiovascular Surgery, Osaka, Japan.
Insights
Long-term left ventricular assist system (LVAS) use in end-stage cardiomyopathy patients can lead to natural heart recovery in some individuals. Patients showing cardiac remodeling were successfully weaned off LVAS and maintained good heart function long-term.
Area of Science:
- Cardiology
- Biomedical Engineering
- Mechanical Circulatory Support
Background:
- End-stage cardiomyopathy significantly impairs cardiac function.
- The long-term effects of left ventricular assist systems (LVAS) on native heart recovery remain unclear.
Purpose of the Study:
- To evaluate the impact of long-term LVAS on native heart recovery in patients with end-stage cardiomyopathy.
- To identify predictors of successful weaning from LVAS.
Main Methods:
- LVAS was implanted in six heart transplant candidates with dilated cardiomyopathy.
- Echocardiography was used to assess native heart size and function during LVAS support.
- Patient recovery and exercise capacity were monitored post-weaning.
Main Results:
- All patients showed improved general condition and systolic function during LVAS support.
- Two patients with significant left ventricular remodeling were weaned off LVAS and maintained good function for years.
- Four patients showed limited remodeling; three could not be weaned, and one died after discontinuation due to infection.
Conclusions:
- Long-term LVAS may facilitate native heart recovery in select end-stage cardiomyopathy patients.
- Cardiac remodeling during LVAS support appears crucial for successful weaning and sustained recovery.
Abstract:
Effects of long-term left ventricular (LV) support on end-stage cardiomyopathy patients is unclear. We applied our LV assist system (LVAS) to six heart transplant candidates, aged 17 to 49, with dilated cardiomyopathy, including one dilated phase hypertrophied cardiomyopathy. LVAS was installed between the left atrium and the ascending aorta, and the pump was positioned parecorporeally. In all patients, their general condition improved, and their pump flows were kept at 4 to 5 L/min. Exercise was started after stabilization of their general condition under constant pump flow. Natural heart size and function were examined by echocardiography. In the beginning of assist, all patients showed impaired cardiac function and LV dilation. During LV assist, systolic function measured by ejection time improved in all patients. Left ventricular end-diastolic dimension (LVDd), showed a remarkable decrease in two patients, who were weaned from LVAS after 3 months of support. They are doing well more than 1 year and 3 years after removal; peak VO2 levels (ml/min/kg) were 30 at 1.2 years and 27 at 2.7 years after removal. In the other four patients, however, LVDd had no remarkable changes, and three could not be weaned from LVAS. The last was discontinued from LVAS after 5 months of support because of infection and died 2 months after removal. From this experience, long-term LVAS may provide the chance for recovery of the natural heart in patients with end-stage cardiomyopathy. The patients whose hearts showed remodeling were able to be weaned from LVAS, and their heart function maintained in good condition for several years.