Left ventricular assist device recovery: does duration of mechanical support matter?
- 264 Downloads
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.
KeywordsHeart failure LVAD Reverse remodeling Cardiac recovery
Compliance with ethical standards
For this type of study (meta-analysis), formal consent is not required.
Conflicts of interest
Mr. Binh Pham has no conflict of interest or financial ties to disclose. Dr. Sandra Chaparro has received research grants from Abbott, Amgen, Mesoblast, and Medtronic.
- 1.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–e603CrossRefGoogle Scholar
- 2.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 CrossRefGoogle Scholar
- 3.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 CrossRefGoogle Scholar
- 5.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 CrossRefGoogle Scholar
- 7.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 CrossRefGoogle Scholar
- 8.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 CrossRefGoogle Scholar
- 9.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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 7:289–296Google Scholar
- 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
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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