Weaning from mechanical support after complete recovery in patients with idiopathic dilated cardiomyopathy

Müller, Johannes; Wallukat, Gerd; Weng, Yuguo; Dandel, Michael; Spiegelsberger, S.; Loebe, Matthias; Hetzer, Roland

doi:10.1007/978-3-642-95984-4_9

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…As a result, two other patients, whose hearts also showed strong signs of recovery, underwent a planned removal of their P-VAD. Since then, the term “bridge to recovery” has become established when the heart has recovered sufficiently after the implantation of a VAD so that it can be removed again and the patient lives on as cured [ 1 ]. While in the early days of cardiac support, when only pulsatile pumps were used, heart recovery was predicted to occur in up to 15% of patients, the overall rate between 2006 and 2015 was 1.3%.…”

Section: Discussionmentioning

confidence: 99%

“…Many VADs that have been developed help support the diseased heart work to provide adequate blood flow. Some hearts were able to recover to the point where a transplant was no longer necessary, and the patients were considered cured [ 1 ]. Since the number of available donor hearts worldwide does not meet the demand, heart disease patients are given different VADs until transplantation time, so they can have a chance to survive the waiting period for a donor’s heart.…”

Section: Introductionmentioning

confidence: 99%

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Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Köhne

2020

J Artif Organs

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Since the first use of a ventricular assist device in 1963 many extracorporeal and implantable pulsatile blood pumps have been developed. After the invention of continuous flow blood pumps the implantable pulsatile pumps are not available anymore. The new rotary pumps spend a better quality of life because many of the patients can go home. Nevertheless, the extracorporeal pulsatile pumps have some advantages. They are low-cost systems, produce less haemolysis and heart-recovery can be tested easily. Pump failure is easy to realize because the pumps can be observed visually. Pump exchange can be done easily without any chirurgic surgery. As volume displacement pumps they can produce high blood pressure, so they are the only ones suitable for pediatric patients. Therefore, they are indispensable for clinical use today and in the future. In this work, nearly all pulsatile blood pumps used in clinical life are described.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Köhne

2020

J Artif Organs

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“…There is general agreement about the importance of ECHO in ascertaining the necessity and feasibility of LVAD support, taking decisions about the need for an additional assist device also for the right-sided heart in LVAD candidates, intraoperative guiding of VAD implantation and adjustment of the assist device flow, as well as post-operative monitoring of the ventricular support including accurate monitoring of the right-sided heart in LVAD recipients (Table 2 , Ref. [ 3 , 4 , 5 , 6 , 7 , 11 , 22 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 ...…”

Section: Role Of Echocardiography In Ventricular Assist Device Therapymentioning

confidence: 99%

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Dandel¹

2022

Rev. Cardiovasc. Med.

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Echocardiography (ECHO) is indispensable for evaluation of patients with terminal chronic heart failure (HF) who require transplantation or mechanical circulatory support by a left- or biventricular assist device (LVAD or BiVAD, respectively). In LVAD candidates, ECHO represents the first-line investigation necessary for a timely discovery of heart-related risk factors for potentially life-threatening post-operative adverse events, including identification of patients who necessitate a biventricular support. ECHO is also required for intra-operative guiding of VAD implantation and finding of the most appropriate setting of the device for an optimal ventricular unloading, postoperative surveillance of the VAD support, and monitoring of the RV changes in LVAD recipients. Thanks to the ECHO, which has decisively contributed to the proof that prolonged VAD support can facilitate cardiac reverse remodeling and functional improvement to levels which allow successful weaning of carefully selected patients from LVAD or BiVAD, the previous opinion that chronic non-ischemic cardiomyopathy (NICMP) is irreversible could be refuted. In patients with normalized and stable right heart catheter-derived hemodynamic parameters obtained at short-term interruptions of VAD support, ECHO has proved able to predict post-weaning long-term freedom from HF recurrence in patients with pre-implant terminal chronic NICMP. The purpose of this article is to offer an actualized theoretical and practical support for clinicians engaged in this particularly challenging and topical issue especially due to the new practical aspects which have emerged in conjunction with the growing use of long-term ventricular assist devices as bridge-to-transplantation or as destination therapy, as well as the increasing evidence that, in some patients, such VAD can become a bridge-to-recovery, allowing the removal of the device after a longer support time.

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“…As shown in Figure 1, the worldwide first elective LVAD explantations in patients with idiopathic dilated cardiomyopathy (IDCM) were performed in 1995 in the German Heart Center Berlin in 4 male patients (age 47±8 years, duration of HF before LVAD implantation 3.5±0.9 years, LV end-diastolic diameter 70±1 mm, LVEF 13%±2%, LVAD support duration 7.2±2.2 months) (15,20,21). One of those patients is still asymptomatic after 25 years since LVAD removal, other 2 patients survived 16.5 and 15 years, respectively, with the native heart, and 1 patient (without post-explant recurrence of HF) died from sepsis, 2.6 years after LVAD explantation.…”

Section: Historical Overview Of the Major Steps Toward The Recognitio...mentioning

confidence: 99%

Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure

Dandel¹,

Javier²,

Delmo³

et al. 2021

Cardiovasc Diagn Ther

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Although complete myocardial recovery after ventricular assist device (VAD) implantation is rather seldom, systematic search for recovery is worthwhile because for recovered patients weaning from VADs is feasible and can provide survival benefits with long-term freedom from heart failure (HF) recurrence, even if a chronic cardiomyopathy was the primary cause for the drug-refractory HF necessitating left ventricular (LVAD) or biventricular support (as bridge-to-transplantation or definitive therapy) and even if recovery remains incomplete.LVAD patients explanted for myoacardial recovery compared to those transplanted from LVAD support showed similar survival rates and a significant proportion of explanted patients can achieve cardiac and physical functional capacities that are within the normal range of healthy controls. In apparently sufficiently recovered patients, a major challenge remains still the pre-explant prediction of the weaning success which is meanwhile reliably possible for experienced clinicians. In weaning candidates, the combined use of certain echocardiography and right heart catheterization parameters recorded before VAD explantation can predict post-weaning cardiac stability with good accuracy. However, in the absence of standardization or binding recommendations, the protocols for assessment of native cardiac improvement and also the weaning criteria differ widely among centers. Currently there are still only few larger studies on myocardial recovery assessment after VAD implantation. Therefore, the weaning practice relies mostly on small case series, local practice patterns, and case reports, and the existing knowledge, as well as the partially differing recommendations which are based mainly on expert opinions, need to be periodically systematised. Addressing these shortcomings, our review aims to summarize the evidence and expert opinion on the evaluation of cardiac recovery during mechanical ventricular support by paying special attention to the reliability of the methods and parameters used for assessment of myocardial recovery and the challenges met in both evaluation of recovery and weaning decision making.

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Weaning from mechanical support after complete recovery in patients with idiopathic dilated cardiomyopathy

Cited by 5 publications

References 30 publications

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure

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