Cardiac recovery in dilated cardiomyopathy by unloading with a left ventricular assist device

Roland Hetzer, Johannes Müller, Yuguo Weng, Gerd Wallukat, Susanne Spiegelsberger, Matthias Loebe

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

Background. Lasting recovery from intractable end-stage dilated cardiomyopathy, which occurs with ventricular unloading, has recently been demonstrated in 5 patients. Here our extended clinical experience with the 'weaning' concept is presented. Methods. In 19 patients (23 to 65 years) with intractable end-stage dilated cardiomyopathy, ventricular assist devices were explanted after support periods of up to 26 months, when repeat off-pump studies had shown either restoration of cardiac function (left ventricular ejection fraction, > 45%) and dimensions (left ventricular internal diameter in diastole, < 55 mm) or partial recovery (left ventricular ejection fraction between 35% and 40%) with serious complications on the device. At the time of device placement left ventricular ejection fraction was below 20% and left ventricular internal diameter in diastole more than 64 mm and bridge-to- transplantation had been planned. Results. Seven patients with persistently restored cardiac function for more than 8 months and 5 patients for less than 5 months after weaning were studied. Five patients with recurrent heart failure died within 4 to 8 months after explantation. Four patients had to be transplanted and 2 died for reasons unrelated to cardiac function. An individual optimal left ventricular ejection fraction and left ventricular internal diameter in diastole was reached before pump removal was actually conducted in all patients. These parameters gradually deteriorated until pump removal. Conclusions. Lasting recovery can be reached by ventricular unloading in a subset of patients with intractable end-stage dilated cardiomyopathy. Obviously, there is an individual optimum of recovery that cannot be further improved by prolonged unloading.

Original languageEnglish (US)
Pages (from-to)742-749
Number of pages8
JournalAnnals of Thoracic Surgery
Volume68
Issue number2
DOIs
StatePublished - Aug 1999
Externally publishedYes

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Heart-Assist Devices
Dilated Cardiomyopathy
Stroke Volume
Diastole
Weaning
Equipment and Supplies
Heart Failure
Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cardiac recovery in dilated cardiomyopathy by unloading with a left ventricular assist device. / Hetzer, Roland; Müller, Johannes; Weng, Yuguo; Wallukat, Gerd; Spiegelsberger, Susanne; Loebe, Matthias.

In: Annals of Thoracic Surgery, Vol. 68, No. 2, 08.1999, p. 742-749.

Research output: Contribution to journalArticle

Hetzer, Roland ; Müller, Johannes ; Weng, Yuguo ; Wallukat, Gerd ; Spiegelsberger, Susanne ; Loebe, Matthias. / Cardiac recovery in dilated cardiomyopathy by unloading with a left ventricular assist device. In: Annals of Thoracic Surgery. 1999 ; Vol. 68, No. 2. pp. 742-749.
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abstract = "Background. Lasting recovery from intractable end-stage dilated cardiomyopathy, which occurs with ventricular unloading, has recently been demonstrated in 5 patients. Here our extended clinical experience with the 'weaning' concept is presented. Methods. In 19 patients (23 to 65 years) with intractable end-stage dilated cardiomyopathy, ventricular assist devices were explanted after support periods of up to 26 months, when repeat off-pump studies had shown either restoration of cardiac function (left ventricular ejection fraction, > 45{\%}) and dimensions (left ventricular internal diameter in diastole, < 55 mm) or partial recovery (left ventricular ejection fraction between 35{\%} and 40{\%}) with serious complications on the device. At the time of device placement left ventricular ejection fraction was below 20{\%} and left ventricular internal diameter in diastole more than 64 mm and bridge-to- transplantation had been planned. Results. Seven patients with persistently restored cardiac function for more than 8 months and 5 patients for less than 5 months after weaning were studied. Five patients with recurrent heart failure died within 4 to 8 months after explantation. Four patients had to be transplanted and 2 died for reasons unrelated to cardiac function. An individual optimal left ventricular ejection fraction and left ventricular internal diameter in diastole was reached before pump removal was actually conducted in all patients. These parameters gradually deteriorated until pump removal. Conclusions. Lasting recovery can be reached by ventricular unloading in a subset of patients with intractable end-stage dilated cardiomyopathy. Obviously, there is an individual optimum of recovery that cannot be further improved by prolonged unloading.",
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