Mechanical Bridging to Improvement in Severe Acute ‘Nonischemic, Nonmyocarditis’ Heart Failure

Abstract

Improved myocardial function has been observed in patients with acute myocarditis who have had short-term support with a ventricular assist system. Additionally, a limited number of patients with nonischemic cardiomyopathy have undergone successful device explantation after their myocardial function improved during ventricular assist system support. The authors present their experience with four patients who had acute, severe heart failure without coronary artery disease or biopsy-proven myocarditis. After receiving prolonged ventricular assist system support, all four patients had significantly improved left ventricular function, returning to New York Heart Association functional class I without inotropic therapy. In each case, dobutamine stress echocardiography and invasive hemodynamic tests were performed to confirm improvement of cardiac function before device explantation was undertaken. In all four cases, device explantation was followed by early successful maintenance of left ventricular function. These cases reveal a unique clinical syndrome that may be successfully treated with early institution of ventricular assist system support followed by explantation after myocardial recovery.

Levitronix Ventricular Assist Devices as a Bridge to Recovery After Profound Biventricular Heart Failure Associated With Pulmonary Aspergillosis

“…16 In the setting of fulminant myocarditis, there may be a role for VAD support, 17 which would be different from the bridge to transplantation 18 and would function as a bridge-to-recovery. 8,15,19 In the recovery setting, most of the decision making is determining who is a good candidate. The decision about whether to bridge to recovery or bridge to transplantation is often not straightforward.…”

Prediction of Cardiac Stability After Weaning From Left Ventricular Assist Devices in Patients With Idiopathic Dilated Cardiomyopathy

“…1,12 Cardiac recovery allowing weaning from VADs was more often detected after acute myocarditis and postcardiotomy HF, but it has been shown that recovery with long-term cardiac stability is also possible in idiopathic dilated cardiomyopathy (IDCM). 3,4,7,8,[12][13][14] However, greatly differing recovery rates after VAD implantation have been reported, especially for IDCM. 12,[15][16][17] These differences may arise from different medical treatments during mechanical unloading and differences in weaning criteria, but also from differences in patient selection for VAD implantation and differences in the mechanical systems used for ventricular support.…”

The paradox of left ventricular assist device unloading and myocardial recovery in end-stage dilated cardiomyopathy: implications for heart failure in the elderly

“…In the late 1990s, there were several case reports and case series of patients with cardiogenic shock in whom LV function improved sufficiently with LVAD support to allow them to be permanently weaned from their devices [56][57][58][59]. One such case series reported by Muller et al [57] in 1997 described 17 patients with idiopathic DCM who received LVAD implantation for cardiogenic shock.…”