Incidence and predictors of myocardial recovery on long-term left ventricular assist device support

Results from the United Network for Organ Sharing database

Stephen Pan, Baran Aksut, Omar E. Wever-Pinzon, Shaline D. Rao, Allison P. Levin, Arthur R. Garan, Justin A. Fried, Koji Takeda, Takayama Hiroo, Melana Yuzefpolskaya, Nir Uriel, Ulrich P. Jorde, Donna M. Mancini, Yoshifumi Naka, Paolo C. Colombo, Veli K. Topkara

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background Mechanical circulatory support (MCS) leads to favorable changes in the failing heart at the molecular, cellular, and structural levels. However, myocardial recovery leading to device explantation is rare. We reasoned that the multicenter United Network for Organ Sharing (UNOS) registry might provide insights into clinical predictors and outcomes of the recovery process. Methods The MCS device data set of the UNOS registry was queried for patients with long-term continuous-flow left ventricular assist devices (CF-LVADs) that were explanted for heart transplantation or indication of recovery. Analysis was restricted to adult patients (≥18 years old) who were listed for an initial heart transplantation. Patients with CF-LVADs that were explanted because of recovery were compared with patients with CF-LVADs who underwent transplantation. Results We identified 594 patients with HeartMate II devices and 92 patients with HeartWare devices. Duration of support was on average 500.4 ± 325.3 days. In 34 (5.0%) patients, devices were explanted secondary to myocardial recovery. Univariate predictors of recovery in patients with long-term LVADs included younger age (40 years vs 53 years), female sex, lower body mass index (25.7 kg/m2 vs 27.9 kg/m2), non-ischemic etiology (91% vs 59%), lack of implantable cardioverter defibrillator at the time of listing (44% vs 79%), and lower serum creatinine (0.97 mg/dl vs 1.28 mg/dl) (all p <0.05). In the post-explantation period, freedom from death or transplantation was 66% at 1 year. Conclusions The incidence of recovery on device support is low in the current MCS era and limited to a select cohort of predominantly young patients with non-ischemic myopathy. Given the high incidence of disease recurrence, patients should be closely followed after device explantation.

Original languageEnglish (US)
Pages (from-to)1624-1629
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Heart-Assist Devices
Databases
Incidence
Equipment and Supplies
Heart Transplantation
Registries
Transplantation
Implantable Defibrillators
Muscular Diseases
Creatinine
Body Mass Index
Recurrence

Keywords

  • device explantation
  • heart transplant
  • left ventricular assist device
  • mechanical circulatory support
  • recovery
  • UNOS registry

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Incidence and predictors of myocardial recovery on long-term left ventricular assist device support : Results from the United Network for Organ Sharing database. / Pan, Stephen; Aksut, Baran; Wever-Pinzon, Omar E.; Rao, Shaline D.; Levin, Allison P.; Garan, Arthur R.; Fried, Justin A.; Takeda, Koji; Hiroo, Takayama; Yuzefpolskaya, Melana; Uriel, Nir; Jorde, Ulrich P.; Mancini, Donna M.; Naka, Yoshifumi; Colombo, Paolo C.; Topkara, Veli K.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 12, 01.12.2015, p. 1624-1629.

Research output: Contribution to journalArticle

Pan, S, Aksut, B, Wever-Pinzon, OE, Rao, SD, Levin, AP, Garan, AR, Fried, JA, Takeda, K, Hiroo, T, Yuzefpolskaya, M, Uriel, N, Jorde, UP, Mancini, DM, Naka, Y, Colombo, PC & Topkara, VK 2015, 'Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: Results from the United Network for Organ Sharing database', Journal of Heart and Lung Transplantation, vol. 34, no. 12, pp. 1624-1629. https://doi.org/10.1016/j.healun.2015.08.004
Pan, Stephen ; Aksut, Baran ; Wever-Pinzon, Omar E. ; Rao, Shaline D. ; Levin, Allison P. ; Garan, Arthur R. ; Fried, Justin A. ; Takeda, Koji ; Hiroo, Takayama ; Yuzefpolskaya, Melana ; Uriel, Nir ; Jorde, Ulrich P. ; Mancini, Donna M. ; Naka, Yoshifumi ; Colombo, Paolo C. ; Topkara, Veli K. / Incidence and predictors of myocardial recovery on long-term left ventricular assist device support : Results from the United Network for Organ Sharing database. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 12. pp. 1624-1629.
@article{22dd22ac689f484d8a9d5197a2640a7e,
title = "Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: Results from the United Network for Organ Sharing database",
abstract = "Background Mechanical circulatory support (MCS) leads to favorable changes in the failing heart at the molecular, cellular, and structural levels. However, myocardial recovery leading to device explantation is rare. We reasoned that the multicenter United Network for Organ Sharing (UNOS) registry might provide insights into clinical predictors and outcomes of the recovery process. Methods The MCS device data set of the UNOS registry was queried for patients with long-term continuous-flow left ventricular assist devices (CF-LVADs) that were explanted for heart transplantation or indication of recovery. Analysis was restricted to adult patients (≥18 years old) who were listed for an initial heart transplantation. Patients with CF-LVADs that were explanted because of recovery were compared with patients with CF-LVADs who underwent transplantation. Results We identified 594 patients with HeartMate II devices and 92 patients with HeartWare devices. Duration of support was on average 500.4 ± 325.3 days. In 34 (5.0{\%}) patients, devices were explanted secondary to myocardial recovery. Univariate predictors of recovery in patients with long-term LVADs included younger age (40 years vs 53 years), female sex, lower body mass index (25.7 kg/m2 vs 27.9 kg/m2), non-ischemic etiology (91{\%} vs 59{\%}), lack of implantable cardioverter defibrillator at the time of listing (44{\%} vs 79{\%}), and lower serum creatinine (0.97 mg/dl vs 1.28 mg/dl) (all p <0.05). In the post-explantation period, freedom from death or transplantation was 66{\%} at 1 year. Conclusions The incidence of recovery on device support is low in the current MCS era and limited to a select cohort of predominantly young patients with non-ischemic myopathy. Given the high incidence of disease recurrence, patients should be closely followed after device explantation.",
keywords = "device explantation, heart transplant, left ventricular assist device, mechanical circulatory support, recovery, UNOS registry",
author = "Stephen Pan and Baran Aksut and Wever-Pinzon, {Omar E.} and Rao, {Shaline D.} and Levin, {Allison P.} and Garan, {Arthur R.} and Fried, {Justin A.} and Koji Takeda and Takayama Hiroo and Melana Yuzefpolskaya and Nir Uriel and Jorde, {Ulrich P.} and Mancini, {Donna M.} and Yoshifumi Naka and Colombo, {Paolo C.} and Topkara, {Veli K.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.healun.2015.08.004",
language = "English (US)",
volume = "34",
pages = "1624--1629",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "12",

}

TY - JOUR

T1 - Incidence and predictors of myocardial recovery on long-term left ventricular assist device support

T2 - Results from the United Network for Organ Sharing database

AU - Pan, Stephen

AU - Aksut, Baran

AU - Wever-Pinzon, Omar E.

AU - Rao, Shaline D.

AU - Levin, Allison P.

AU - Garan, Arthur R.

AU - Fried, Justin A.

AU - Takeda, Koji

AU - Hiroo, Takayama

AU - Yuzefpolskaya, Melana

AU - Uriel, Nir

AU - Jorde, Ulrich P.

AU - Mancini, Donna M.

AU - Naka, Yoshifumi

AU - Colombo, Paolo C.

AU - Topkara, Veli K.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background Mechanical circulatory support (MCS) leads to favorable changes in the failing heart at the molecular, cellular, and structural levels. However, myocardial recovery leading to device explantation is rare. We reasoned that the multicenter United Network for Organ Sharing (UNOS) registry might provide insights into clinical predictors and outcomes of the recovery process. Methods The MCS device data set of the UNOS registry was queried for patients with long-term continuous-flow left ventricular assist devices (CF-LVADs) that were explanted for heart transplantation or indication of recovery. Analysis was restricted to adult patients (≥18 years old) who were listed for an initial heart transplantation. Patients with CF-LVADs that were explanted because of recovery were compared with patients with CF-LVADs who underwent transplantation. Results We identified 594 patients with HeartMate II devices and 92 patients with HeartWare devices. Duration of support was on average 500.4 ± 325.3 days. In 34 (5.0%) patients, devices were explanted secondary to myocardial recovery. Univariate predictors of recovery in patients with long-term LVADs included younger age (40 years vs 53 years), female sex, lower body mass index (25.7 kg/m2 vs 27.9 kg/m2), non-ischemic etiology (91% vs 59%), lack of implantable cardioverter defibrillator at the time of listing (44% vs 79%), and lower serum creatinine (0.97 mg/dl vs 1.28 mg/dl) (all p <0.05). In the post-explantation period, freedom from death or transplantation was 66% at 1 year. Conclusions The incidence of recovery on device support is low in the current MCS era and limited to a select cohort of predominantly young patients with non-ischemic myopathy. Given the high incidence of disease recurrence, patients should be closely followed after device explantation.

AB - Background Mechanical circulatory support (MCS) leads to favorable changes in the failing heart at the molecular, cellular, and structural levels. However, myocardial recovery leading to device explantation is rare. We reasoned that the multicenter United Network for Organ Sharing (UNOS) registry might provide insights into clinical predictors and outcomes of the recovery process. Methods The MCS device data set of the UNOS registry was queried for patients with long-term continuous-flow left ventricular assist devices (CF-LVADs) that were explanted for heart transplantation or indication of recovery. Analysis was restricted to adult patients (≥18 years old) who were listed for an initial heart transplantation. Patients with CF-LVADs that were explanted because of recovery were compared with patients with CF-LVADs who underwent transplantation. Results We identified 594 patients with HeartMate II devices and 92 patients with HeartWare devices. Duration of support was on average 500.4 ± 325.3 days. In 34 (5.0%) patients, devices were explanted secondary to myocardial recovery. Univariate predictors of recovery in patients with long-term LVADs included younger age (40 years vs 53 years), female sex, lower body mass index (25.7 kg/m2 vs 27.9 kg/m2), non-ischemic etiology (91% vs 59%), lack of implantable cardioverter defibrillator at the time of listing (44% vs 79%), and lower serum creatinine (0.97 mg/dl vs 1.28 mg/dl) (all p <0.05). In the post-explantation period, freedom from death or transplantation was 66% at 1 year. Conclusions The incidence of recovery on device support is low in the current MCS era and limited to a select cohort of predominantly young patients with non-ischemic myopathy. Given the high incidence of disease recurrence, patients should be closely followed after device explantation.

KW - device explantation

KW - heart transplant

KW - left ventricular assist device

KW - mechanical circulatory support

KW - recovery

KW - UNOS registry

UR - http://www.scopus.com/inward/record.url?scp=84951573731&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951573731&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2015.08.004

DO - 10.1016/j.healun.2015.08.004

M3 - Article

VL - 34

SP - 1624

EP - 1629

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 12

ER -