Temporare mechanische linksherzentlastung. Erholung der herzfunktion bei patienten mit idiopathischer dilatativer kardiomyopathie im endstadium

Translated title of the contribution: Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy

J. Müller, G. Wallukat, Yu Guo Weng, M. Dandel, S. Spiegelsberger, S. Semrau, K. Brandes, H. Bieda, M. Hummel, Matthias Loebe, R. Meyer, R. Hetzer

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Implantation of a mechanical cardiac support system (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. Our experience now includes 13 patients who have been 'weaned' from MCSS and we report about the overall results of this treatment as well as the effects of ventricular unloading on cardiac function, anti-β1-adrenoceptor-autoantibody (A-β1-AAB) level and the degree of myocardial fibrosis. Methods: 13 patients with non-ischemic IDC who had been admitted here in cardiogenic shock (CI < 1.6 l · min-1, left ventricular ejection fraction [LVEF] < 16% and left ventricular internal diameter in diastole [LVIDd] > 68 mm) and who all tested positive for A- β1-AABs were implanted with an uni-(12 patients) or a biventricular (1 patient) mechanical assist device. Echocardiographic evaluation and A-β1- AAB-level-monitoring was routinely performed after implantation and explantation of the MCSS and the degree of myocardial fibrosis was assessed at the time of implantation and after explnation. Results: During a mean duration of mechanical support of 236 ± 201 days (range: 30 to 794 days), LV-EF improved to a mean of 46% and LVIDd decreased to a mean value of 56 mm in these 13 patients. A-β1-AABs decreased and disappeared 11.7 weeks after implantation of the device and did not reincrease thereafter. The highly pathologic degree of fibrosis at the time of implantation diminished to normal values about 1 year after explantation. One patient died of anesthesiologic complications and another patient shortly presented with a new episode of cardiac insufficiency 6 months after explantation. He was implanted again with an univentricular assist device was successfully transplanted 3 weeks later. Mean observation period of the remaining 11 patients now amounts to 12.6 ± 9.77 (range: 3 to 26) months after explantation of the device - as of May, 31, 1997 - with a cumulative observation period of 139 patient months. Conclusion: Temporary implantation of a MCSS may normalize cardiac function in selected patients with IDC. The striking degree of myocardial fibrosis can reduce to normal values after explantation of the device. A-β1-AABs disappear during ventricular unloading and do not increase thereafter. 'Weaning' from mechanical device may constitute an alternative treatment to cardiac transplantation in selected patients.

Original languageGerman
Pages (from-to)227-236
Number of pages10
JournalHerz
Volume22
Issue number5
StatePublished - Oct 1997
Externally publishedYes

Fingerprint

Dilated Cardiomyopathy
Weaning
Equipment and Supplies
Fibrosis
Reference Values
Observation
Cardiogenic Shock
Heart Transplantation
Autoantibodies
Adrenergic Receptors

Keywords

  • Anti-β-adrenoceptor autoantibodies
  • Idiopathic dilated cardiomyopathy
  • Mechanical cardiac support system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Müller, J., Wallukat, G., Weng, Y. G., Dandel, M., Spiegelsberger, S., Semrau, S., ... Hetzer, R. (1997). Temporare mechanische linksherzentlastung. Erholung der herzfunktion bei patienten mit idiopathischer dilatativer kardiomyopathie im endstadium. Herz, 22(5), 227-236.

Temporare mechanische linksherzentlastung. Erholung der herzfunktion bei patienten mit idiopathischer dilatativer kardiomyopathie im endstadium. / Müller, J.; Wallukat, G.; Weng, Yu Guo; Dandel, M.; Spiegelsberger, S.; Semrau, S.; Brandes, K.; Bieda, H.; Hummel, M.; Loebe, Matthias; Meyer, R.; Hetzer, R.

In: Herz, Vol. 22, No. 5, 10.1997, p. 227-236.

Research output: Contribution to journalArticle

Müller, J, Wallukat, G, Weng, YG, Dandel, M, Spiegelsberger, S, Semrau, S, Brandes, K, Bieda, H, Hummel, M, Loebe, M, Meyer, R & Hetzer, R 1997, 'Temporare mechanische linksherzentlastung. Erholung der herzfunktion bei patienten mit idiopathischer dilatativer kardiomyopathie im endstadium', Herz, vol. 22, no. 5, pp. 227-236.
Müller J, Wallukat G, Weng YG, Dandel M, Spiegelsberger S, Semrau S et al. Temporare mechanische linksherzentlastung. Erholung der herzfunktion bei patienten mit idiopathischer dilatativer kardiomyopathie im endstadium. Herz. 1997 Oct;22(5):227-236.
Müller, J. ; Wallukat, G. ; Weng, Yu Guo ; Dandel, M. ; Spiegelsberger, S. ; Semrau, S. ; Brandes, K. ; Bieda, H. ; Hummel, M. ; Loebe, Matthias ; Meyer, R. ; Hetzer, R. / Temporare mechanische linksherzentlastung. Erholung der herzfunktion bei patienten mit idiopathischer dilatativer kardiomyopathie im endstadium. In: Herz. 1997 ; Vol. 22, No. 5. pp. 227-236.
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abstract = "Background: Implantation of a mechanical cardiac support system (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. Our experience now includes 13 patients who have been 'weaned' from MCSS and we report about the overall results of this treatment as well as the effects of ventricular unloading on cardiac function, anti-β1-adrenoceptor-autoantibody (A-β1-AAB) level and the degree of myocardial fibrosis. Methods: 13 patients with non-ischemic IDC who had been admitted here in cardiogenic shock (CI < 1.6 l · min-1, left ventricular ejection fraction [LVEF] < 16{\%} and left ventricular internal diameter in diastole [LVIDd] > 68 mm) and who all tested positive for A- β1-AABs were implanted with an uni-(12 patients) or a biventricular (1 patient) mechanical assist device. Echocardiographic evaluation and A-β1- AAB-level-monitoring was routinely performed after implantation and explantation of the MCSS and the degree of myocardial fibrosis was assessed at the time of implantation and after explnation. Results: During a mean duration of mechanical support of 236 ± 201 days (range: 30 to 794 days), LV-EF improved to a mean of 46{\%} and LVIDd decreased to a mean value of 56 mm in these 13 patients. A-β1-AABs decreased and disappeared 11.7 weeks after implantation of the device and did not reincrease thereafter. The highly pathologic degree of fibrosis at the time of implantation diminished to normal values about 1 year after explantation. One patient died of anesthesiologic complications and another patient shortly presented with a new episode of cardiac insufficiency 6 months after explantation. He was implanted again with an univentricular assist device was successfully transplanted 3 weeks later. Mean observation period of the remaining 11 patients now amounts to 12.6 ± 9.77 (range: 3 to 26) months after explantation of the device - as of May, 31, 1997 - with a cumulative observation period of 139 patient months. Conclusion: Temporary implantation of a MCSS may normalize cardiac function in selected patients with IDC. The striking degree of myocardial fibrosis can reduce to normal values after explantation of the device. A-β1-AABs disappear during ventricular unloading and do not increase thereafter. 'Weaning' from mechanical device may constitute an alternative treatment to cardiac transplantation in selected patients.",
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AU - Müller, J.

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AU - Weng, Yu Guo

AU - Dandel, M.

AU - Spiegelsberger, S.

AU - Semrau, S.

AU - Brandes, K.

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AU - Meyer, R.

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N2 - Background: Implantation of a mechanical cardiac support system (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. Our experience now includes 13 patients who have been 'weaned' from MCSS and we report about the overall results of this treatment as well as the effects of ventricular unloading on cardiac function, anti-β1-adrenoceptor-autoantibody (A-β1-AAB) level and the degree of myocardial fibrosis. Methods: 13 patients with non-ischemic IDC who had been admitted here in cardiogenic shock (CI < 1.6 l · min-1, left ventricular ejection fraction [LVEF] < 16% and left ventricular internal diameter in diastole [LVIDd] > 68 mm) and who all tested positive for A- β1-AABs were implanted with an uni-(12 patients) or a biventricular (1 patient) mechanical assist device. Echocardiographic evaluation and A-β1- AAB-level-monitoring was routinely performed after implantation and explantation of the MCSS and the degree of myocardial fibrosis was assessed at the time of implantation and after explnation. Results: During a mean duration of mechanical support of 236 ± 201 days (range: 30 to 794 days), LV-EF improved to a mean of 46% and LVIDd decreased to a mean value of 56 mm in these 13 patients. A-β1-AABs decreased and disappeared 11.7 weeks after implantation of the device and did not reincrease thereafter. The highly pathologic degree of fibrosis at the time of implantation diminished to normal values about 1 year after explantation. One patient died of anesthesiologic complications and another patient shortly presented with a new episode of cardiac insufficiency 6 months after explantation. He was implanted again with an univentricular assist device was successfully transplanted 3 weeks later. Mean observation period of the remaining 11 patients now amounts to 12.6 ± 9.77 (range: 3 to 26) months after explantation of the device - as of May, 31, 1997 - with a cumulative observation period of 139 patient months. Conclusion: Temporary implantation of a MCSS may normalize cardiac function in selected patients with IDC. The striking degree of myocardial fibrosis can reduce to normal values after explantation of the device. A-β1-AABs disappear during ventricular unloading and do not increase thereafter. 'Weaning' from mechanical device may constitute an alternative treatment to cardiac transplantation in selected patients.

AB - Background: Implantation of a mechanical cardiac support system (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. Our experience now includes 13 patients who have been 'weaned' from MCSS and we report about the overall results of this treatment as well as the effects of ventricular unloading on cardiac function, anti-β1-adrenoceptor-autoantibody (A-β1-AAB) level and the degree of myocardial fibrosis. Methods: 13 patients with non-ischemic IDC who had been admitted here in cardiogenic shock (CI < 1.6 l · min-1, left ventricular ejection fraction [LVEF] < 16% and left ventricular internal diameter in diastole [LVIDd] > 68 mm) and who all tested positive for A- β1-AABs were implanted with an uni-(12 patients) or a biventricular (1 patient) mechanical assist device. Echocardiographic evaluation and A-β1- AAB-level-monitoring was routinely performed after implantation and explantation of the MCSS and the degree of myocardial fibrosis was assessed at the time of implantation and after explnation. Results: During a mean duration of mechanical support of 236 ± 201 days (range: 30 to 794 days), LV-EF improved to a mean of 46% and LVIDd decreased to a mean value of 56 mm in these 13 patients. A-β1-AABs decreased and disappeared 11.7 weeks after implantation of the device and did not reincrease thereafter. The highly pathologic degree of fibrosis at the time of implantation diminished to normal values about 1 year after explantation. One patient died of anesthesiologic complications and another patient shortly presented with a new episode of cardiac insufficiency 6 months after explantation. He was implanted again with an univentricular assist device was successfully transplanted 3 weeks later. Mean observation period of the remaining 11 patients now amounts to 12.6 ± 9.77 (range: 3 to 26) months after explantation of the device - as of May, 31, 1997 - with a cumulative observation period of 139 patient months. Conclusion: Temporary implantation of a MCSS may normalize cardiac function in selected patients with IDC. The striking degree of myocardial fibrosis can reduce to normal values after explantation of the device. A-β1-AABs disappear during ventricular unloading and do not increase thereafter. 'Weaning' from mechanical device may constitute an alternative treatment to cardiac transplantation in selected patients.

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