(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
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