Top

Published in:

01-03-2019

Left ventricular assist device recovery: does duration of mechanical support matter?

Authors: Binh N. Pham, Sandra V. Chaparro

Published in: Heart Failure Reviews | Issue 2/2019

Abstract

Heart failure is a widespread condition in the United States that is predicted to significantly increase in prevalence in the next decade. Many heart failure patients are given a left ventricular assist device (LVAD) while they wait for a heart transplant, while those that are not able to undergo a heart transplant may be given an LVAD permanently. However, past studies have observed a small subset of heart failure patients that recovered cardiac function of their native heart after being placed on an LVAD. As a result, some patients have been able to have their LVAD explanted and no longer needed a heart transplant. In this review, we analyzed the data of 15 studies that observed recovery of cardiac function in LVAD patients in order to investigate the effects that duration of LVAD support has on patient outcomes. From our review, we identified that there may be negative consequences of prolonged duration of mechanical support such as myocardial atrophy and abnormal calcium cycling as well as circumstances that may allow for a longer duration of LVAD support such as in patients using a continuous-flow LVAD, non-ischemic cardiomyopathy patients, and the specific pharmacological therapy.

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2017) Heart disease and stroke statistics’ 2017 update: a report from the American Heart Association. Circulation 135:e146–e603CrossRefPubMedPubMedCentral

Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, Ikonomidis JS, Khavjou O, Konstam MA, Maddox TM, Nichol G, Pham M, Piña IL, Trogdon JG, American Heart Association Advocacy Coordinating Committee, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Stroke Council (2013) Forecasting the impact of heart failure in the United States a policy statement from the American Heart Association. Circ Heart Fail 6:606–619. https://doi.org/10.1161/HHF.0b013e318291329a CrossRefPubMedPubMedCentral

Goldstein DJ, Maybaum S, MacGillivray TE, Moore SA, Bogaev R, Farrar DJ, Frazier OH, HeartMate II Clinical Investigators (2012) Young patients with nonischemic cardiomyopathy have higher likelihood of left ventricular recovery during left ventricular assist device support. J Card Fail 18:392–395. https://doi.org/10.1016/j.cardfail.2012.01.020 CrossRefPubMed

Burkhoff D, Klotz S, Mancini DM (2006) LVAD-induced reverse remodeling: basic and clinical implications for myocardial recovery. J Card Fail 12:227–239. https://doi.org/10.1016/j.cardfail.2005.10.012 CrossRefPubMed

Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, Miller MA, Baldwin JT, Young JB, Naftel DC (2017) Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant 36:1080–1086. https://doi.org/10.1016/j.healun.2017.07.005 CrossRefPubMed

Hetzer R, Müller J, Weng Y, Wallukat G, Spiegelsberger S, Loebe M (1999) Cardiac recovery in dilated cardiomyopathy by unloading with a left ventricular assist device. Ann Thorac Surg 68:742–749. https://doi.org/10.1016/S0003-4975(99)00542-1 CrossRefPubMed

Drakos SG, Wever-Pinzon O, Selzman CH, Gilbert EM, Alharethi R, Reid BB, Saidi A, Diakos NA, Stoker S, Davis ES, Movsesian M, Li DY, Stehlik J, Kfoury AG, UCAR (Utah Cardiac Recovery Program) Investigators (2013) Magnitude and time course of changes induced by continuous-flow left ventricular assist device unloading in chronic heart failure: insights into cardiac recovery. J Am Coll Cardiol 61:1985–1994. https://doi.org/10.1016/j.jacc.2013.01.072 CrossRefPubMed

Xydas S, Rosen RS, Ng C, Mercando M, Cohen J, DiTullio M, Magnano A, Marboe CC, Mancini DM, Naka Y, Oz MC, Maybaum S (2006) Mechanical unloading leads to echocardiographic, electrocardiographic, neurohormonal, and histologic recovery. J Heart Lung Transplant 25:7–15. https://doi.org/10.1016/j.healun.2005.08.001 CrossRefPubMed

Farrar DJ, Holman WR, McBride LR, Kormos RL, Icenogle TB, Hendry PJ, Moore CH, Loisance DY, el-Banayosy A, Frazier H (2002) Long-term follow-up of thoratec ventricular assist device bridge-to-recovery patients successfully removed from support after recovery of ventricular function. J Heart Lung Transplant 21:516–521. https://doi.org/10.1016/S1053-2498(01)00408-9 CrossRefPubMed

10.

Dandel M, Weng Y, Siniawski H, Potapov E, Krabatsch T, Lehmkuhl HB, Drews T, Knosalla C, Hetzer R (2012) Pre-explant stability of unloading-promoted cardiac improvement predicts outcome after weaning from ventricular assist devices. Circulation 126. https://doi.org/10.1161/CIRCULATIONAHA.111.084640

11.

Dandel M, Weng Y, Siniawski H, Stepanenko A, Krabatsch T, Potapov E, Lehmkuhl HB, Knosalla C, Hetzer R (2011) Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices. Eur Heart J 32:1148–1160. https://doi.org/10.1093/eurheartj/ehq353 CrossRefPubMed

12.

Oriyanhan W, Tsuneyoshi H, Nishina T, Matsuoka S, Ikeda T, Komeda M (2007) Determination of optimal duration of mechanical unloading for failing hearts to achieve bridge to recovery in a rat heterotopic heart transplantation model. J Heart Lung Transplant 26:16–23. https://doi.org/10.1016/j.healun.2006.10.016 CrossRefPubMed

13.

Kinoshita M, Takano H, Takaichi S, Taenaka Y, Nakatani T (1996) Influence of prolonged ventricular assistance on myocardial histopathology in intact heart. Ann Thorac Surg 61:640–645. https://doi.org/10.1016/0003-4975(95)01087-4 CrossRefPubMed

14.

Ogletree ML, Sweet WE, Talerico C, Klecka ME, Young JB, Smedira NG, Starling RC, Moravec CS (2010) Duration of left ventricular assist device support: effects on abnormal calcium cycling and functional recovery in the failing human heart. J Heart Lung Transplant 29:554–561. https://doi.org/10.1016/j.healun.2009.10.015 CrossRefPubMed

15.

Butler CR, Jugdutt BI (2012) The paradox of left ventricular assist device unloading and myocardial recovery in end-stage dilated cardiomyopathy: implications for heart failure in the elderly. Heart Fail Rev 17:615–633. https://doi.org/10.1007/s10741-012-9300-8 CrossRefPubMed

16.

Boehmer JP, Starling RC, Cooper LT, Torre-Amione G, Wittstein I, Dec GW, Markham DW, Zucker MJ, Gorcsan J 3rd, McTiernan C, Kip K, McNamara D, IMAC Investigators (2012) Left ventricular assist device support and myocardial recovery in recent onset cardiomyopathy. J Card Fail 18:755–761. https://doi.org/10.1016/j.cardfail.2012.08.001 CrossRefPubMed

17.

Dandel M, Hetzer R (2015) Myocardial recovery during mechanical circulatory support: long-term outcome and elective ventricular assist device implantation to promote recovery as a treatment goal. Heart Lung Vessel 7:289–296PubMedPubMedCentral

18.

Dandel M, Weng Y, Siniawski H et al (2005) Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices. Circulation 112. https://doi.org/10.1161/CIRCULATIONAHA.104.525352

19.

Dandel M, Weng Y, Siniawski H, Potapov E, Drews T, Lehmkuhl HB, Knosalla C, Hetzer R (2008) Prediction of cardiac stability after weaning from left ventricular assist devices in patients with idiopathic dilated cardiomyopathy. Circulation 118. https://doi.org/10.1161/CIRCULATIONAHA.107.755983

20.

Cheng A, Williamitis CA, Slaughter MS (2014) Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to pulsatility? Ann Cardiothorac Surg 3:573–581. https://doi.org/10.3978/5143 CrossRefPubMedPubMedCentral

21.

Diakos NA, Selzman CH, Sachse FB, Stehlik J, Kfoury AG, Wever-Pinzon O, Catino A, Alharethi R, Reid BB, Miller DV, Salama M, Zaitsev AV, Shibayama J, Li H, Fang JC, Li DY, Drakos SG (2014) Myocardial atrophy and chronic mechanical unloading of the failing human heart: implications for cardiac assist device-induced myocardial recovery. J Am Coll Cardiol 64:1602–1612. https://doi.org/10.1016/j.jacc.2014.05.073 CrossRefPubMed

22.

Birks EJ, George RS, Hedger M, Bahrami T, Wilton P, Bowles CT, Webb C, Bougard R, Amrani M, Yacoub MH, Dreyfus G, Khaghani A (2011) Reversal of severe heart failure with a continuous-flow left ventricular assist device and pharmacological therapy: a prospective study. Circulation 123:381–390. https://doi.org/10.1161/CIRCULATIONAHA.109.933960 CrossRefPubMed

23.

Birks EJ, Drakos SG, Lowes BD, Patel SR, Selzman C, Slaughter MS, Alturi P, Goldstein D, Um J, Cunningham C, Margulies KB, Stehlik J, Starling R, Farrar D, Rame E (2018) Outcome and primary endpoint results from a prospective multi-center study of myocardial recovery using LVADs: remission from stage D heart failure (RESTAGE-HF). J Heart Lung Transplant 37:S142. https://doi.org/10.1016/j.healun.2018.01.342 CrossRef

24.

Frazier OH, Baldwin ACW, Demirozu ZT, et al (2015) Ventricular reconditioning and pump explantation in patients supported by continuous-flow left ventricular assist devices. J Heart Lung Transplant 34:766–772. https://doi.org/10.1016/j.healun.2014.09.015 CrossRefPubMed

25.

Tchantchaleishvili V, Cheyne C, Sherazi S, et al (2016) Single-center experience with HeartMate II left ventricular assist device explantation. Artif Organs 40:1145–1149. https://doi.org/10.1111/aor.12688 CrossRefPubMed

26.

Wever-Pinzon J, Selzman CH, Stoddard G, Wever-Pinzon O, Catino A, Kfoury AG, Diakos NA, Reid BB, McKellar S, Bonios M, Koliopoulou A, Budge D, Kelkhoff A, Stehlik J, Fang JC, Drakos SG (2016) Impact of ischemic heart failure etiology on cardiac recovery during mechanical unloading. J Am Coll Cardiol 68:1741–1752. https://doi.org/10.1016/j.jacc.2016.07.756 CrossRefPubMed

27.

Wever-Pinzon O, Drakos SG, McKellar SH et al (2016) Cardiac recovery during long-term left ventricular assist device support. J Am Coll Cardiol 68:1540–1553. https://doi.org/10.1016/j.jacc.2016.07.743 CrossRefPubMed

28.

Birks EJ, Tansley PD, Hardy J, George RS, Bowles CT, Burke M, Banner NR, Khaghani A, Yacoub MH (2006) Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med 355:1873–1884. https://doi.org/10.1056/NEJMoa053063 CrossRefPubMed

29.

Phan K, Huo YR, Zhao DF, Yan TD, Tchantchaleishvili V (2016) Ventricular recovery and pump explantation in patients supported by left ventricular assist devices: a systematic review. ASAIO J 62:219–231. https://doi.org/10.1097/MAT.0000000000000328 CrossRefPubMed

30.

Maybaum S, Mancini D, Xydas S, Starling RC, Aaronson K, Pagani FD, Miller LW, Margulies K, McRee S, Frazier OH, Torre-Amione G, LVAD Working Group (2007) Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD working group. Circulation 115:2497–2505. https://doi.org/10.1161/CIRCULATIONAHA.106.633180 CrossRefPubMed

31.

Yacoub MH (2001) A novel strategy to maximize the efficacy of left ventricular assist devices as a bridge to recovery. Eur Heart J 22:534–540CrossRefPubMed

32.

Wong K, Boheler KR, Bishop J, Petrou M, Yacoub MH (1998) Clenbuterol induces cardiac hypertrophy with normal functional, morphological and molecular features. Cardiovasc Res 37:115–122. https://doi.org/10.1016/S0008-6363(97)00190-9 CrossRefPubMed

33.

Hon JKF, Yacoub MH (2003) Bridge to recovery with the use of left ventricular assist device and clenbuterol. Ann Thorac Surg 75(6):S36–S41. https://doi.org/10.1016/S0003-4975(03)00460-0

34.

Krabatsch T, Schweiger M, Dandel M, et al (2011) Is bridge to recovery more likely with pulsatile left ventricular assist devices than with nonpulsatile-flow systems? Ann Thorac Surg 91:1335–1340. https://doi.org/10.1016/j.athoracsur.2011.01.027 CrossRefPubMed

Title: Left ventricular assist device recovery: does duration of mechanical support matter?
Authors: Binh N. Pham
Sandra V. Chaparro
Publication date: 01-03-2019
Publisher: Springer US
Published in: Heart Failure Reviews / Issue 2/2019
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-018-9744-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Left ventricular assist device recovery: does duration of mechanical support matter?

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2019

Mitochondrial membrane transporters and metabolic switch in heart failure

Chronic heart failure: a disease of the brain

Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management

Diabetic cardiomyopathy: molecular mechanisms, detrimental effects of conventional treatment, and beneficial effects of natural therapy

Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure: a meta-analysis of cohort studies

Structural and functional abnormalities in iron-depleted heart

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page