Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: Results from the United Network for Organ Sharing database

Pan, Stephen; Aksut, Baran; Wever-Pinzon, Omar; Rao, Shaline; Levin, A.P.; Garan, A.R.; Fried, Justin; Takeda, Koji; Takayama, Hiroaki; Yuzefpolskaya, M.; Uriel, Nir; Jorde, Ulrich P.; Mancini, Donna; Naka, Yoshifumi; Colombo, P.C.; Topkara, V.K.

doi:10.1016/j.healun.2015.08.004

Cited by 49 publications

(49 citation statements)

References 26 publications

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“…60% (12 out of 20) of patients with chronic non-ischemic cardiomyopathy supported with CF-LVAD were successfully explanted using this protocol, however results from the multicenter Harefield Recovery Protocol Study (HARPS) were not replicated in the United States 12 . Moreover, “real world” data from this study and other multicenter registries demonstrate substantially lower rates of myocardial recovery observed in LVAD patients 18, 21 . Although many reasons can account for the variability observed; differences in patient selection, pharmacologic management, assessment of cardiac function on pump support, speed optimization protocols, and device explantation criteria used are potential contributors to this discrepancy.…”

Section: Discussionmentioning

confidence: 55%

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Topkara

Garan

Fine

et al. 2016

Circ: Heart Failure

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122

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Background Time course and predictors of myocardial recovery on contemporary LVAD support is poorly defined due to limited number of recovery patients at any implanting center. This study sought to investigate myocardial recovery using multicenter data from INTERMACS. Methods and Results 13,454 adult patients were studied. Device explant rates for myocardial recovery were 0.9% at 1-year, 1.9% at 2-year, and 3.1% at 3-year follow-up. Independent predictors of device explantation for recovery were age < 50 years (OR 2.5), non-ischemic etiology (OR 5.4), time since initial diagnosis < 2 years (OR 3.4), suboptimal HF therapy prior to implant (OR 2.2), LVEDD < 6.5 cm (OR 1.7), pulmonary systolic artery pressure < 50 mmHg (OR 2.0), BUN <30 mg/dL (OR 3.3), and axial-flow device (OR 7.6). Patients with myocarditis (7.7%), postpartum (4.4%) and adriamycin-induced cardiomyopathy (4.1%) had highest rates of device explantation for recovery. Use of neurohormonal blockers on LVAD support was significantly higher in patients who were explanted for recovery. Importantly, 9% of all LVAD patients who were not explanted for recovery have demonstrated substantial improvement in LVEF (partial recovery), and had remarkable overlap in clinical characteristic profile compared to patients who were explanted for recovery (complete recovery). Complete and partial recovery rates have declined in parallel with recent changes observed in device indications and technology. Conclusions Myocardial recovery is a spectrum of improvement rather than a binary clinical end-point. One in every ten LVAD patients demonstrates partial or complete myocardial recovery and should be targeted for functional assessment and optimization.

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Section: Discussionmentioning

confidence: 55%

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Topkara

Garan

Fine

et al. 2016

Circ: Heart Failure

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122

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“…Further to this point, as noted above, patients more likely to recover during LVAD support are the younger cohort, with idiopathic cardiomyopathy, with a relatively short duration of symptoms (24). Interestingly, these characteristics overlap with those of patients more likely to recover with other forms of therapy, including beta-blockers and CRT; the so-called super responders” (18, 19, 25) (Fig.…”

Section: Incidence Of Lvad-induced Recovery/remissionmentioning

confidence: 87%

“…A recent study evaluated UNOS registry data that included 594 patients receiving a HeartMate II and 92 patients with an HVAD, who were supported for an average of 500.4±325.3 days (24). It was observed that 5% of these patients were explanted in the setting of recovered LV function.…”

Section: Factors Associated With Recovery/remissionmentioning

confidence: 99%

Left ventricular assist device-induced reverse remodeling: it’s not just about myocardial recovery

Marinescu

Uriel

Mann

et al. 2016

Expert Review of Medical Devices

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Introduction The abnormal structure, function and molecular makeup of dilated cardiomyopathic hearts can be partially normalized in patients supported by a left ventricular assist device (LVAD), a process called reverse remodeling. This leads to recovery of function in many patients, though the rate of full recovery is low and in many cases is temporary, leading to the concept of heart failure remission, rather than recovery. Areas covered We summarize data indicative of ventricular reverse remodeling, recovery and remission during LVAD support. These terms were used in searches performed in Pubmed. Duplication of topics covered in depth in prior review articles were avoided. Expert Commentary Although most patients undergoing mechanical circulatory support (MCS) show a significant degree of reverse remodeling, very few exhibit sufficiently improved function to justify device explantation, and many from whom LVADs have been explanted have relapsed back to the original heart failure phenotype. Future research has the potential to clarify the ideal combination of pharmacological, cell, gene, and mechanical therapies that would maximize recovery of function which has the potential to improve exercise tolerance of patients while on support, and to achieve a higher degree of myocardial recovery that is more likely to persist after device removal.

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“…Published series report significant variation in the proportion of patients that recover from <1% to 73% . The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) is the largest international dataset of durable MCS implants and reports a bridge‐to‐recovery (BTR) rate of 0.9% .…”

Section: Incidence Of Recoverymentioning

confidence: 99%

“…Six patients (9%) underwent device explantation for recovery although no standardized explant criteria were employed and optimal anti‐HF drug therapy not defined. Further series have reported varying rates of recovery with MCS between 4% and 11% . However, these observational reports either do not employ a standardized protocol for device explant assessment, include significant proportions of patients with reversible aetiologies or have high rates of HF relapse .…”

Section: Incidence Of Recoverymentioning

confidence: 99%

Myocardial recovery with mechanical circulatory support

Chaggar

Williams²,

Yonan³

et al. 2016

European J of Heart Fail

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Mechanical circulatory support (MCS) is instituted in patients with advanced heart failure, some of who may experience sufficient recovery in cardiac function to allow withdrawal of mechanical support. The incidence of left ventricular recovery with MCS is unclear as reported series in the literature demonstrate widely divergent rates. A number of clinical parameters (including echocardiographic, haemodynamic and physiological) are used to indicate likely left ventricular recovery during pump speed reduction but no internationally agreed definition exists. Withdrawal of MCS is not without risk and so robust clinical and biochemical definitions are important to minimize patient morbidity and mortality. Here we review our current understanding of left ventricular recovery with MCS.

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Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: Results from the United Network for Organ Sharing database

Cited by 49 publications

References 26 publications

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Left ventricular assist device-induced reverse remodeling: it’s not just about myocardial recovery

Myocardial recovery with mechanical circulatory support

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