Clinical researchSuccessful Weaning and Explantation of the Heartmate II Left Ventricular Assist Device
Section snippets
Indications
Patients with HF were considered potential candidates for VAD support if they developed decompensated HF unresponsive to full medical therapy including inotropic and/or vasopressor support. Objective evidence of decompensated HF such as hypotension, decreased cardiac output, or signs of end organ hypoperfusion was required. Patients with ischemic and nonischemic cardiomyopathy were eligible. Patients with absolute contraindications to cardiac transplantation such as active significant infection
Results
Between January 2008 and April 2009, the HMII LVAD was implanted into 17 patients for decompensated HF with the intent of bridging these patients to cardiac transplantation at St-Paul's Hospital, which serves as the single provincial referral centre for HF in British Columbia, Canada. Two patients (12%) died early post HMII implantation from multisystem organ failure. Four patients (24%) were successfully bridged to cardiac transplantation. Eight patients (47%) in this cohort are currently
Discussion
Mechanical circulatory support with LVAD for patients with decompensated HF is well described. Many critically ill patients have been successfully supported to cardiac transplantation. Although bridge to transplant has remained the primary goal of VAD therapy, transplant is fraught with its own complications and the need for chronic immunosuppression. A more desirable outcome of device therapy would be the complete recovery of native LV function, thus obviating the need for transplantation.
Conclusions
This report illustrates the possibility of reverse remodelling of the left ventricle of patients with severe HF who were implanted with a nonpulsatile LVAD and are receiving aggressive medical therapy. The LVADs were weaned according to a protocol and the procedures were performed through minimally invasive incisions without cardiopulmonary bypass support. Many unanswered questions remain about weaning patients from continuous-flow VADs, mostly concerning the long-term outcomes of those
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (43)
Experience with a standardized protocol to predict successful explantation of left ventricular assist devices
2022, Journal of Thoracic and Cardiovascular SurgeryClinical myocardial recovery in advanced heart failure with long term left ventricular assist device support
2022, Journal of Heart and Lung TransplantationCitation Excerpt :Although an LVEDD between 55 and 60 mm can be considered borderline normal in patients with a body surface area ≥1.8 m2, an LVEDD >55 mm was associated with post explant recurrence of HF within 3 years.29 Also, the RESTAGE-HF protocol specified pump speed optimization to achieve mitral regurgitation less than grade 2, while other studies required all valvular regurgitation (aortic, tricuspid, pulmonic) to be less than grade 229,49 “Normal” criteria for right ventricular structure and function included outflow tract diameter <35 mm, right ventricular short and/or long axis ratio <0.619 right ventricular ejection fraction >40%,49 or more vaguely, “good” right ventricular function.55 Additional information on ventricular function can be obtained by tissue Doppler imaging and assessment of regional wall thickness, which also help assess the risk of HF recurrence.56
Myocarditis
2022, Cardiovascular PathologyExpanding the Scope of Multimodality Imaging in Durable Mechanical Circulatory Support
2020, JACC: Cardiovascular ImagingOutcomes from a recovery protocol for patients with continuous-flow left ventricular assist devices
2019, Journal of Heart and Lung TransplantationCitation Excerpt :The next step in our protocol was GrOccl. Invasive hemodynamic measurement has been described by many investigators.16,18,25 On the other hand, some groups performed explantation without standardized invasive hemodynamic evaluation.26–28
Ventricular assist device therapy
2018, Critical Heart Disease in Infants and Children
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