(Circulation. 1998;98:2383-2389.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure
From the Divisions of Circulatory Physiology (D.M.M., A.B., M.E.C.) and Cardiology (D.M.M., A.B., H.L., M.D., S.S.) and the Division of Cardiothoracic Surgery (K.C., M.F., E.R., M.O.), Columbia Presbyterian Medical Center, New York, NY.
Background—Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation.
Methods and Results—A retrospective review of patients receiving
a mechanical bridge to transplantation at Columbia Presbyterian
Hospital after July 21, 1991, was performed to determine the
incidence of patients in whom the device was successfully explanted.
From August 1, 1996, to February 1, 1998, we prospectively attempted to
identify potential explant candidates by the use of exercise testing.
During this time, we recruited 39 consecutive patients after insertion
of the Thermo Cardiosystems vented electric device to participate in
the following study. Approximately 3 months after device implantation,
a maximal exercise test with hemodynamic monitoring and
respiratory gas analysis was performed with the LVAD in the
automated mode. The electric device was interfaced with a pneumatic
console such that the rate could be decreased to 20 cycles/min.
Hemodynamic measurements were recorded as the
device rate was decreased. A repeat exercise test was then performed if
the patient remained hemodynamically stable. A
retrospective chart review of 111 LVAD recipients at our institution
identified only 5 successful explant patients. Eighteen of the 39
patients were studied. Fifteen patients exercised with maximal device
support. At peak exercise, 
O2 averaged
14.5±3.6 mL · kg-1 · min-1;
LVAD flow, 8.0±1.3 L/min; Fick cardiac output, 11.4±3.3 L/min; and
pulmonary capillary wedge pressure, 13±4 mm Hg. Seven
patients remained normotensive and could exercise at a fixed rate of 20
cycles/min. In these patients, peak
O2 declined from 17.3±3.9 to 13.0±6.1
mL · kg-1 · min-1. In one of
these patients, the device was explanted.
Conclusions—Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted.
Key Words: heart-assist device • heart failure
This article has been cited by other articles:
 |
|
 |
|
  G. K.R. Soppa, J. Lee, M. A. Stagg, L. E. Felkin, P. J.R. Barton, U. Siedlecka, S. Youssef, M. H. Yacoub, and C. M.N. Terracciano Role and possible mechanisms of clenbuterol in enhancing reverse remodelling during mechanical unloading in murine heart failure Cardiovasc Res, March 1, 2008; 77(4): 695 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. George and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2008; 3(2008): 669 - 696. [Full Text]
|
|
|
|
|
|
S. Aggarwal, F. Cheema, M. C. Oz, and Y. Naka Long-Term Mechanical Circulatory Support Card. Surg. Adult, January 1, 2008; 3(2008): 1609 - 1628. [Full Text]
|
|
|
|
 |
|
 S. Maybaum, D. Mancini, S. Xydas, R. C. Starling, K. Aaronson, F. D. Pagani, L. W. Miller, K. Margulies, S. McRee, O.H. Frazier, et al. Cardiac Improvement During Mechanical Circulatory Support: A Prospective Multicenter Study of the LVAD Working Group Circulation, May 15, 2007; 115(19): 2497 - 2505. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Klotz, A.H. J. Danser, R. F. Foronjy, M. C. Oz, J. Wang, D. Mancini, J. D'Armiento, and D. Burkhoff The Impact of Angiotensin-Converting Enzyme Inhibitor Therapy on the Extracellular Collagen Matrix During Left Ventricular Assist Device Support in Patients With End-Stage Heart Failure J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1166 - 1174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Bugger, S. Leippert, D. Blum, P. Kahle, B. Barleon, D. Marme, and T. Doenst Subtractive hybridization for differential gene expression in mechanically unloaded rat heart Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2714 - H2722. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Birks, P. D. Tansley, J. Hardy, R. S. George, C. T. Bowles, M. Burke, N. R. Banner, A. Khaghani, and M. H. Yacoub Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure N. Engl. J. Med., November 2, 2006; 355(18): 1873 - 1884. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Klotz, J. Stypmann, H. Welp, C. Schmid, G. Drees, A. Rukosujew, and H. H. Scheld Does Continuous Flow Left Ventricular Assist Device Technology Have a Positive Impact on Outcome Pretransplant and Posttransplant? Ann. Thorac. Surg., November 1, 2006; 82(5): 1774 - 1778. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Cullen, A. H.Y. Yuen, L. E. Felkin, R. T. Smolenski, J. L. Hall, S. Grindle, L. W. Miller, E. J. Birks, M. H. Yacoub, and P. J.R. Barton Myocardial Expression of the Arginine:Glycine Amidinotransferase Gene Is Elevated in Heart Failure and Normalized After Recovery: Potential Implications for Local Creatine Synthesis Circulation, July 4, 2006; 114(1_suppl): I-16 - I-20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Wohlschlaeger, K. J. Schmitz, C. Schmid, K. W. Schmid, P. Keul, A. Takeda, S. Weis, B. Levkau, and H. A. Baba Reverse remodeling following insertion of left ventricular assist devices (LVAD): A review of the morphological and molecular changes Cardiovasc Res, December 1, 2005; 68(3): 376 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Matsumiya, O. Monta, N. Fukushima, Y. Sawa, T. Funatsu, K. Toda, and H. Matsuda Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy? J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 699 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Simon, R. L. Kormos, S. Murali, P. Nair, M. Heffernan, J. Gorcsan, S. Winowich, and D. M. McNamara Myocardial Recovery Using Ventricular Assist Devices: Prevalence, Clinical Characteristics, and Outcomes Circulation, August 30, 2005; 112(9_suppl): I-32 - I-36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. R. Barton, L. E. Felkin, E. J. Birks, M. E. Cullen, N. R. Banner, S. Grindle, J. L. Hall, L. W. Miller, and M. H. Yacoub Myocardial Insulin-Like Growth Factor-I Gene Expression During Recovery From Heart Failure After Combined Left Ventricular Assist Device and Clenbuterol Therapy Circulation, August 30, 2005; 112(9_suppl): I-46 - I-50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Tsuneyoshi, W. Oriyanhan, H. Kanemitsu, R. Shiina, T. Nishina, S. Matsuoka, T. Ikeda, and M. Komeda Does the {beta}2-Agonist Clenbuterol Help to Maintain Myocardial Potential to Recover During Mechanical Unloading? Circulation, August 30, 2005; 112(9_suppl): I-51 - I-56. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Birks, J. L. Hall, P. J.R. Barton, S. Grindle, N. Latif, J. P. Hardy, J. E. Rider, N. R. Banner, A. Khaghani, L. W. Miller, et al. Gene Profiling Changes in Cytoskeletal Proteins During Clinical Recovery After Left Ventricular-Assist Device Support Circulation, August 30, 2005; 112(9_suppl): I-57 - I-64. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mancini and D. Burkhoff Mechanical Device-Based Methods of Managing and Treating Heart Failure Circulation, July 19, 2005; 112(3): 438 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Klotz, R. F. Foronjy, M. L. Dickstein, A. Gu, I. M. Garrelds, A.H. Jan Danser, M. C. Oz, J. D'Armiento, and D. Burkhoff Mechanical Unloading During Left Ventricular Assist Device Support Increases Left Ventricular Collagen Cross-Linking and Myocardial Stiffness Circulation, July 19, 2005; 112(3): 364 - 374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Mizuno, R. D. Weisel, and R.-K. Li Reloading the heart: A new animal model of left ventricular assist device removal J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 99 - 106. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Patten, D. DeNofrio, M. El-Zaru, R. Kakkar, J. Saunders, F. Celestin, K. Warner, H. Rastegar, K. R. Khabbaz, J. E. Udelson, et al. Ventricular Assist Device Therapy Normalizes Inducible Nitric Oxide Synthase Expression and Reduces Cardiomyocyte Apoptosis in the Failing Human Heart J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1419 - 1424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Starling Inducible Nitric Oxide Synthase in Severe Human Heart Failure: Impact of Mechanical Unloading J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1425 - 1427. [Full Text] [PDF]
|
|
|
|
|
|
S. Klotz, A. Barbone, S. Reiken, J. W. Holmes, Y. Naka, M. C. Oz, A. R. Marks, and D. Burkhoff Left ventricular assist device support normalizes left and right ventricular beta-adrenergic pathway properties J. Am. Coll. Cardiol., March 1, 2005; 45(5): 668 - 676. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pieske Reverse remodeling in heart failure - fact or fiction? Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D66 - D78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Colson, F. Ryckwaert, M. Saussine, M. Ferriere, and B. Albat Monitoring weaning from BIVAD thoratec with peak oxygen consumption Ann. Thorac. Surg., May 1, 2004; 77(5): 1808 - 1810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Klotz, M. C. Deng, J. Stypmann, J. Roetker, M. J. Wilhelm, D. Hammel, H. H. Scheld, and C. Schmid Left ventricular pressure and volume unloading during pulsatile versus nonpulsatile left ventricular assist device support Ann. Thorac. Surg., January 1, 2004; 77(1): 143 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. W. Stevenson and E. A. Rose Left Ventricular Assist Devices: Bridges to Transplantation, Recovery, and Destination for Whom? Circulation, December 23, 2003; 108(25): 3059 - 3063. [Full Text] [PDF]
|
|
|
|
|
|
J. K. F. Hon and M. H. Yacoub Bridge to recovery with the use of left ventricular assist device and clenbuterol Ann. Thorac. Surg., June 1, 2003; 75(90060): S36 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. C. Blaxall, B. M. Tschannen-Moran, C. A. Milano, and W. J. Koch Differential gene expression and genomic patient stratification following left ventricular assist device support J. Am. Coll. Cardiol., April 2, 2003; 41(7): 1096 - 1106. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Lee, W. Ting, and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2003; 2(2003): 639 - 658. [Full Text]
|
|
|
|
|
|
E. L. Kukuy, M. C. Oz, and Y. Naka Long-Term Mechanical Circulatory Support Card. Surg. Adult, January 1, 2003; 2(2003): 1491 - 1506. [Full Text]
|
|
|
|
|
|
H. T. Tevaearai, G. B. Walton, A. D. Eckhart, J. R. Keys, and W. J. Koch Heterotopic transplantation as a model to study functional recovery of unloaded failing hearts J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1149 - 1156. [Abstract] [Full Text]
|
|
|
|
|
|
H. T. Tevaearai, A. D. Eckhart, G. B. Walton, J. R. Keys, K. Wilson, and W. J. Koch Myocardial Gene Transfer and Overexpression of {beta}2-Adrenergic Receptors Potentiates the Functional Recovery of Unloaded Failing Hearts Circulation, July 2, 2002; 106(1): 124 - 129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. de Jonge, D. F. van Wichen, M. E. I. Schipper, J. R. Lahpor, F. H. J. Gmelig-Meyling, E. O. Robles de Medina, and R. A. de Weger Left ventricular assist device in end-stage heart failure: persistence of structural myocyte damage after unloading: An immunohistochemical analysis of the contractile myofilaments J. Am. Coll. Cardiol., March 20, 2002; 39(6): 963 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Chatterjee Refractory heart failure--drugs and devices Eur. Heart J., December 2, 2001; 22(24): 2227 - 2230. [PDF]
|
|
|
|
|
|
Y. Y. Li, Y. Feng, C. F. McTiernan, W. Pei, C. S. Moravec, P. Wang, W. Rosenblum, R. L. Kormos, and A. M. Feldman Downregulation of Matrix Metalloproteinases and Reduction in Collagen Damage in the Failing Human Heart After Support With Left Ventricular Assist Devices Circulation, September 4, 2001; 104(10): 1147 - 1152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Ochiai, L. A.R. Golding, A. L. Massiello, A. L. Medvedev, R. L. Gerhart, J.-F. Chen, M. Takagaki, and K. Fukamachi In vivo hemodynamic performance of the Cleveland Clinic CorAide blood pump in calves Ann. Thorac. Surg., September 1, 2001; 72(3): 747 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Minami Surgical Treatments for Endstage Heart Failure Due to Dilated Cardiomyopathy Asian Cardiovasc Thorac Ann, September 1, 2001; 9(3): 159 - 166. [Full Text] [PDF]
|
|
|
|
|
|
A. Barbone, J. W. Holmes, P. M. Heerdt, A. H.S. The', Y. Naka, N. Joshi, M. Daines, A. R. Marks, M. C. Oz, and D. Burkhoff Comparison of Right and Left Ventricular Responses to Left Ventricular Assist Device Support in Patients With Severe Heart Failure: A Primary Role of Mechanical Unloading Underlying Reverse Remodeling Circulation, August 7, 2001; 104(6): 670 - 675. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Madigan, A. Barbone, A. F. Choudhri, D. L. S. Morales, B. Cai, M. C. Oz, and D. Burkhoff Time course of reverse remodeling of the left ventricle during support with a left ventricular assist device J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 902 - 908. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.H. Yacoub A novel strategy to maximize the efficacy of left ventricular assist devices as a bridge to recovery Eur. Heart J., April 1, 2001; 22(7): 534 - 540. [PDF]
|
|
|
|
|
|
M. A. Acker Mechanical circulatory support for patients with acute-fulminant myocarditis Ann. Thorac. Surg., March 1, 2001; 71 (2007): S73 - S76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hetzer, J. H. Muller, Y.-g. Weng, R. Meyer, and M. Dandel Bridging-to-recovery Ann. Thorac. Surg., March 1, 2001; 71 (2007): S109 - S113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Slaughter, M. A. Silver, D. J. Farrar, A. J. Tatooles, and P. S. Pappas A new method of monitoring recovery and weaning the thoratec left ventricular assist device Ann. Thorac. Surg., January 1, 2001; 71(1): 215 - 218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Vermes, R. Houel, M. Simon, P. Le Besnerais, and D. Loisance Doppler tissue imaging to predict myocardial recovery during mechanical circulatory support Ann. Thorac. Surg., December 1, 2000; 70(6): 2149 - 2151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Heerdt, J. W. Holmes, B. Cai, A. Barbone, J. D. Madigan, S. Reiken, D. L. Lee, M. C. Oz, A. R. Marks, and D. Burkhoff Chronic Unloading by Left Ventricular Assist Device Reverses Contractile Dysfunction and Alters Gene Expression in End-Stage Heart Failure Circulation, November 28, 2000; 102(22): 2713 - 2719. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mital, K. E. Loke, L. J. Addonizio, M. C. Oz, and T. H. Hintze Left ventricular assist device implantation augments nitric oxide dependent control of mitochondrial respiration in failing human hearts J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1897 - 1902. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hetzer, J. H. Muller, Y.-G. Weng, M. Loebe, and G. Wallukat Midterm follow-up of patients who underwent removal of a left ventricular assist device after cardiac recovery from end-stage dilated cardiomyopathy J. Thorac. Cardiovasc. Surg., November 1, 2000; 120(5): 843 - 855. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. N. Helman, S. W. Maybaum, D. L.S. Morales, M. R. Williams, A. Beniaminovitz, N. M. Edwards, D. M. Mancini, and M. C. Oz Recurrent remodeling after ventricular assistance: is long-term myocardial recovery attainable? Ann. Thorac. Surg., October 1, 2000; 70(4): 1255 - 1258. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Westaby HEART FAILURE: Non-transplant surgery for heart failure Heart, May 1, 2000; 83(5): 603 - 603. [Full Text]
|
|
|
|
|
|
S. J. Park, D. Q. Nguyen, A. J. Bank, S. Ormaza, and R. M. Bolman III Left ventricular assist device bridge therapy for acute myocardial infarction Ann. Thorac. Surg., April 1, 2000; 69(4): 1146 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Mann and J. T. Willerson Left Ventricular Assist Devices and the Failing Heart : A Bridge to Recovery, a Permanent Assist Device, or a Bridge Too Far? Circulation, December 1, 1998; 98(22): 2367 - 2369. [Full Text] [PDF]
|
|