This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: May 15, 2007, Volume 115, Number 19 Data Supplement All Versions of this Article: 115/19/2497    most recent CIRCULATIONAHA.106.633180v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maybaum, S. Search for Related Content PubMed PubMed Citation Articles by Maybaum, S. Related Collections Congestive Remodeling Heart failure - basic studies CV surgery: transplantation, ventricular assistance, cardiomyopathy Related Article

(Circulation. 2007;115:2497-2505.)
© 2007 American Heart Association, Inc.

Heart Failure

Cardiac Improvement During Mechanical Circulatory Support

A Prospective Multicenter Study of the LVAD Working Group

Simon Maybaum, MD; Donna Mancini, MD^*; Steve Xydas, MD^*; Randall C. Starling, MD, MPH; Keith Aaronson, MD, MS; Francis D. Pagani, MD, PhD; Leslie W. Miller, MD; Kenneth Margulies, MD; Susan McRee, RN, BSN; O.H. Frazier, MD; Guillermo Torre-Amione, MD, PhD, for the LVAD Working Group

From Albert Einstein College of Medicine, Bronx, NY (S.M.); Columbia University College of Physicians and Surgeons, New York, NY (D.M., S.X.); Cleveland Clinic, Cleveland, Ohio (R.C.S.); University of Michigan Health System, Ann Arbor (K.A., F.D.P.); University of Minnesota, Minneapolis (L.W.M.); University of Pennsylvania, Philadelphia (K.M.); Texas Heart Institute, Houston (O.H.F.); and Methodist DeBakey Heart Center, Baylor College of Medicine, Houston, Tex (S.M., G.T.-A.). Dr Miller is currently at the Georgetown Hospital Center, Washington, DC.

Correspondence to Simon Maybaum, MD, Albert Einstein College of Medicine, Center for Advanced Cardiac Therapy, 3400 Bainbridge Ave, 7th Floor, Bronx, NY 10467-2490. E-mail smaybaum{at}montefiore.org

Received July 31, 2006; accepted March 4, 2007.

Background— Myocardial recovery after left ventricular assist device (LVAD) support has been reported. The LVAD Working Group Recovery Study was a prospective multicenter trial to assess the incidence of myocardial recovery in patients bridged to cardiac transplantation.

Methods and Results— After LVAD implantation, patients were evaluated with the use of rest echocardiograms with partial LVAD support and cardiopulmonary exercise testing. Dobutamine echocardiography with hemodynamic measurements was performed in those patients with left ventricular ejection fraction >40% during resting studies. Histological analysis was performed on myocardial samples taken at LVAD implantation and explantation. Sixty-seven LVAD patients with heart failure participated in the study. After 30 days, significant improvement occurred in left ventricular ejection fraction (17±7% versus 34±12%; P<0.001) and reductions in left ventricular end-diastolic diameter (7.1±1.2 versus 5.1±1.1 cm; P<0.001) and left ventricular mass (320±113 versus 194±79 g; P<0.001) compared with before LVAD. Thirty-four percent of patients had left ventricular ejection fraction >40% with partial device support. Left ventricular ejection fraction decreased over time to pre-LVAD measurement by 120 days. Peak O₂ improved with mechanical support (13.7±4.2 versus 18.9±5.5 mL/kg per minute, 30 versus 120 days; P<0.001). Tissue analysis revealed significant reductions in myocyte size, collagen content, and cardiac tumor necrosis factor-. Six subjects (9%) underwent LVAD explantation for recovery.

Conclusions— Cardiac function improves significantly after device implantation. Although cellular recovery and improvement in ventricular function are observed, the degree of clinical recovery is insufficient for device explantation in most patients with chronic heart failure.

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CLINICAL PERSPECTIVE

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