Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy

Johannes Müller, Gerd Wallukat, Yu Guo Weng, Michael Dandel, Susanne Spiegelsberger, Sabine Semrau, Kersten Brandes, Vassilis Theodoridis, Matthias Loebe, Rudolf Meyer, Roland Hetzer

Research output: Contribution to journalArticle

302 Citations (Scopus)

Abstract

Background: Implantation of mechanical cardiac support systems (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. We report of long-term effects of ventricular unloading on cardiac function, humoral anti-β1-adrenoceptor autoantibodies (A-β1-AABs), and myocardial fibrosis. Methods and Results: Seventeen patients in New York Heart Association functional class IV with nonischemic IDC received MCSS. All had a cardiac index of <1.6 L·min- 1·m-2 of body surface area, a left ventricular ejection fraction (LVEF) of <16%, and a left ventricular internal diameter in diastole (LVIDd) of >68 mm and tested positive for A-β1-AABs. Echocardiographic evaluation, serum tests for A-β1-AABs, and histological assessment of myocardial fibrosis were performed before and after MCSS implantation. The mean support duration was 230±201 days. Six patients died, four were transplanted, and two are still on MCSS. Five patients with significant cardiac recovery (mean LVIDd, 54±2.3 mm; LVEF, 47±3.7%) were weaned after 160 to 794 days and are now device free for 51 to 592 days. A-β1-AABs disappeared gradually during MCSS without increase after weaning; cardiac function and volume density of fibrosis remained normal. Nine patients' cardiac function hardly improved during ventricular unloading. Conclusions: Cardiac function can be normalized in selected patients with end-stage IDC by MCSS. The degree of preoperative myocardial fibrosis may be an indicator for outcome; A-β1-AABs can be used to monitor myocyte recovery. Weaning from MCSS offers an alternative to cardiac transplantation in certain patients.

Original languageEnglish (US)
Pages (from-to)542-549
Number of pages8
JournalCirculation
Volume96
Issue number2
StatePublished - Jul 15 1997
Externally publishedYes

Fingerprint

Dilated Cardiomyopathy
Weaning
Autoantibodies
Adrenergic Receptors
Fibrosis
Equipment and Supplies
Cardiac Volume
Heart Transplantation
Muscle Cells
Serum

Keywords

  • Assist devices
  • Cardiomyopathy
  • Implantation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Müller, J., Wallukat, G., Weng, Y. G., Dandel, M., Spiegelsberger, S., Semrau, S., ... Hetzer, R. (1997). Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy. Circulation, 96(2), 542-549.

Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy. / Müller, Johannes; Wallukat, Gerd; Weng, Yu Guo; Dandel, Michael; Spiegelsberger, Susanne; Semrau, Sabine; Brandes, Kersten; Theodoridis, Vassilis; Loebe, Matthias; Meyer, Rudolf; Hetzer, Roland.

In: Circulation, Vol. 96, No. 2, 15.07.1997, p. 542-549.

Research output: Contribution to journalArticle

Müller, J, Wallukat, G, Weng, YG, Dandel, M, Spiegelsberger, S, Semrau, S, Brandes, K, Theodoridis, V, Loebe, M, Meyer, R & Hetzer, R 1997, 'Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy', Circulation, vol. 96, no. 2, pp. 542-549.
Müller J, Wallukat G, Weng YG, Dandel M, Spiegelsberger S, Semrau S et al. Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy. Circulation. 1997 Jul 15;96(2):542-549.
Müller, Johannes ; Wallukat, Gerd ; Weng, Yu Guo ; Dandel, Michael ; Spiegelsberger, Susanne ; Semrau, Sabine ; Brandes, Kersten ; Theodoridis, Vassilis ; Loebe, Matthias ; Meyer, Rudolf ; Hetzer, Roland. / Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy. In: Circulation. 1997 ; Vol. 96, No. 2. pp. 542-549.
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abstract = "Background: Implantation of mechanical cardiac support systems (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. We report of long-term effects of ventricular unloading on cardiac function, humoral anti-β1-adrenoceptor autoantibodies (A-β1-AABs), and myocardial fibrosis. Methods and Results: Seventeen patients in New York Heart Association functional class IV with nonischemic IDC received MCSS. All had a cardiac index of <1.6 L·min- 1·m-2 of body surface area, a left ventricular ejection fraction (LVEF) of <16{\%}, and a left ventricular internal diameter in diastole (LVIDd) of >68 mm and tested positive for A-β1-AABs. Echocardiographic evaluation, serum tests for A-β1-AABs, and histological assessment of myocardial fibrosis were performed before and after MCSS implantation. The mean support duration was 230±201 days. Six patients died, four were transplanted, and two are still on MCSS. Five patients with significant cardiac recovery (mean LVIDd, 54±2.3 mm; LVEF, 47±3.7{\%}) were weaned after 160 to 794 days and are now device free for 51 to 592 days. A-β1-AABs disappeared gradually during MCSS without increase after weaning; cardiac function and volume density of fibrosis remained normal. Nine patients' cardiac function hardly improved during ventricular unloading. Conclusions: Cardiac function can be normalized in selected patients with end-stage IDC by MCSS. The degree of preoperative myocardial fibrosis may be an indicator for outcome; A-β1-AABs can be used to monitor myocyte recovery. Weaning from MCSS offers an alternative to cardiac transplantation in certain patients.",
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AU - Weng, Yu Guo

AU - Dandel, Michael

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AU - Semrau, Sabine

AU - Brandes, Kersten

AU - Theodoridis, Vassilis

AU - Loebe, Matthias

AU - Meyer, Rudolf

AU - Hetzer, Roland

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N2 - Background: Implantation of mechanical cardiac support systems (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. We report of long-term effects of ventricular unloading on cardiac function, humoral anti-β1-adrenoceptor autoantibodies (A-β1-AABs), and myocardial fibrosis. Methods and Results: Seventeen patients in New York Heart Association functional class IV with nonischemic IDC received MCSS. All had a cardiac index of <1.6 L·min- 1·m-2 of body surface area, a left ventricular ejection fraction (LVEF) of <16%, and a left ventricular internal diameter in diastole (LVIDd) of >68 mm and tested positive for A-β1-AABs. Echocardiographic evaluation, serum tests for A-β1-AABs, and histological assessment of myocardial fibrosis were performed before and after MCSS implantation. The mean support duration was 230±201 days. Six patients died, four were transplanted, and two are still on MCSS. Five patients with significant cardiac recovery (mean LVIDd, 54±2.3 mm; LVEF, 47±3.7%) were weaned after 160 to 794 days and are now device free for 51 to 592 days. A-β1-AABs disappeared gradually during MCSS without increase after weaning; cardiac function and volume density of fibrosis remained normal. Nine patients' cardiac function hardly improved during ventricular unloading. Conclusions: Cardiac function can be normalized in selected patients with end-stage IDC by MCSS. The degree of preoperative myocardial fibrosis may be an indicator for outcome; A-β1-AABs can be used to monitor myocyte recovery. Weaning from MCSS offers an alternative to cardiac transplantation in certain patients.

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