Young patients with nonischemic cardiomyopathy have higher likelihood of left ventricular recovery during left ventricular assist device support

Daniel J. Goldstein, Simon Maybaum, Thomas E. MacGillivray, Stephanie A. Moore, Roberta Bogaev, David J. Farrar, O. Howard Frazier

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Recovery of ventricular function during left ventricular assist device (LVAD) support allowing device explantation occurs infrequently. We explored the hypothesis that certain patient profiles are more likely to exhibit LV recovery during LVAD support. Methods and Results: A retrospective analysis of data from the HeartMate II bridge to transplant (BTT) and destination therapy (DT) trials was conducted, including 490 BTT, 600 DT, and 18 compassionate-use patients. Of the 1,108 patients, 20 (1.8%; 10 BTT, 10 DT) were explanted owing to LV recovery. The median age was 33 years, and 12 patients (60%) were <40 years of age. History of heart failure was <1 year for 11 patients (61%), and the primary etiology was nonischemic (90%). Of the patients with nonischemic etiologies and <1-year history of heart failure, 13% were explanted. Three patients required LVAD reimplantation; of the remaining 17, 16 remain alive. At follow-up (median 510 days), the mean ejection fraction was 42% (20%-67%) and the mean left ventricular end-diastolic diameter was 55 ± 8 mm. At the 2-year follow-up (n = 13), patients were New York Heart Association functional class I or II and overall survival rate was 85 ± 11%. Conclusions: The results of this study suggest that LV recovery is most likely to occur in young patients (<40 years) with nonischemic cardiomyopathy of <1 year duration. Two-year postexplant survival was excellent.

Original languageEnglish (US)
Pages (from-to)392-395
Number of pages4
JournalJournal of Cardiac Failure
Volume18
Issue number5
DOIs
StatePublished - May 2012

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Heart-Assist Devices
Cardiomyopathies
Transplants
Heart Failure
Compassionate Use Trials
Ventricular Function
Replantation
Recovery of Function
Therapeutics
Survival Rate
Equipment and Supplies
Survival

Keywords

  • Heart failure
  • LVAD
  • myocardial recovery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Young patients with nonischemic cardiomyopathy have higher likelihood of left ventricular recovery during left ventricular assist device support. / Goldstein, Daniel J.; Maybaum, Simon; MacGillivray, Thomas E.; Moore, Stephanie A.; Bogaev, Roberta; Farrar, David J.; Frazier, O. Howard.

In: Journal of Cardiac Failure, Vol. 18, No. 5, 05.2012, p. 392-395.

Research output: Contribution to journalArticle

Goldstein, Daniel J. ; Maybaum, Simon ; MacGillivray, Thomas E. ; Moore, Stephanie A. ; Bogaev, Roberta ; Farrar, David J. ; Frazier, O. Howard. / Young patients with nonischemic cardiomyopathy have higher likelihood of left ventricular recovery during left ventricular assist device support. In: Journal of Cardiac Failure. 2012 ; Vol. 18, No. 5. pp. 392-395.
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abstract = "Background: Recovery of ventricular function during left ventricular assist device (LVAD) support allowing device explantation occurs infrequently. We explored the hypothesis that certain patient profiles are more likely to exhibit LV recovery during LVAD support. Methods and Results: A retrospective analysis of data from the HeartMate II bridge to transplant (BTT) and destination therapy (DT) trials was conducted, including 490 BTT, 600 DT, and 18 compassionate-use patients. Of the 1,108 patients, 20 (1.8{\%}; 10 BTT, 10 DT) were explanted owing to LV recovery. The median age was 33 years, and 12 patients (60{\%}) were <40 years of age. History of heart failure was <1 year for 11 patients (61{\%}), and the primary etiology was nonischemic (90{\%}). Of the patients with nonischemic etiologies and <1-year history of heart failure, 13{\%} were explanted. Three patients required LVAD reimplantation; of the remaining 17, 16 remain alive. At follow-up (median 510 days), the mean ejection fraction was 42{\%} (20{\%}-67{\%}) and the mean left ventricular end-diastolic diameter was 55 ± 8 mm. At the 2-year follow-up (n = 13), patients were New York Heart Association functional class I or II and overall survival rate was 85 ± 11{\%}. Conclusions: The results of this study suggest that LV recovery is most likely to occur in young patients (<40 years) with nonischemic cardiomyopathy of <1 year duration. Two-year postexplant survival was excellent.",
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N2 - Background: Recovery of ventricular function during left ventricular assist device (LVAD) support allowing device explantation occurs infrequently. We explored the hypothesis that certain patient profiles are more likely to exhibit LV recovery during LVAD support. Methods and Results: A retrospective analysis of data from the HeartMate II bridge to transplant (BTT) and destination therapy (DT) trials was conducted, including 490 BTT, 600 DT, and 18 compassionate-use patients. Of the 1,108 patients, 20 (1.8%; 10 BTT, 10 DT) were explanted owing to LV recovery. The median age was 33 years, and 12 patients (60%) were <40 years of age. History of heart failure was <1 year for 11 patients (61%), and the primary etiology was nonischemic (90%). Of the patients with nonischemic etiologies and <1-year history of heart failure, 13% were explanted. Three patients required LVAD reimplantation; of the remaining 17, 16 remain alive. At follow-up (median 510 days), the mean ejection fraction was 42% (20%-67%) and the mean left ventricular end-diastolic diameter was 55 ± 8 mm. At the 2-year follow-up (n = 13), patients were New York Heart Association functional class I or II and overall survival rate was 85 ± 11%. Conclusions: The results of this study suggest that LV recovery is most likely to occur in young patients (<40 years) with nonischemic cardiomyopathy of <1 year duration. Two-year postexplant survival was excellent.

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