Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy?

Matsumiya, Goro; Monta, Osamu; Fukushima, Norihide; Sawa, Yoshiki; Funatsu, Toshihiro; Toda, K.; Matsuda, Hikaru

doi:10.1016/j.jtcvs.2005.05.016

Cited by 66 publications

(50 citation statements)

References 22 publications

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“…[42][43][44] Patients with a broad scar lesion, which is assessed by end-myocardial biopsy, cardiac magnetic resonance imaging, or myocardial scintigraphy, have less chance to achieve LVRR. 45,46) Simon, et al showed that a short duration of HF is a positive factor to achieve LVRR during LVAD treatment, because remodeling is not severe in such myocardium and there is a chance to recover. 47) We have demonstrated that preoperative "insufficient" β-blocker treatment is a strong predictor of LVRR during LVAD treatment.…”

Section: Preoperative β-Blocker Treatment and LV Reverse Remodeling (mentioning

confidence: 99%

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

Imamura

Kinugawa

2016

Int. Heart J.

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SummarySurvival rate in patients with stage D heart failure has improved significantly owing to the development of continuous flow left ventricular assist devices (LVAD), but aortic insufficiency (AI) still remains one of the major unsolved complications that impairs patient quality of life. There are no established treatments for AI, and preoperative prediction and prevention of AI is needed. The opening of a native aortic valve (AV) is a sufficient condition for prevention of AI, and improvement of LV ejection fraction due to LV reverse remodeling (LVRR) is essential to open a native AV. Preoperative insufficient β-blocker treatment and pulsatile flow LVAD usage are keys for LVRR, opening of an AV, and prevention of AI. The second mechanism that leads to AI is remodeling of the aortic root and degeneration of a native AV, which results from reduced pulse pressure during LVAD support. Centrifugal or pulsatile flow LVAD usage has an advantage in terms of preserving pulsatility, and may prevent AI compared with an axial pump. There is less probability of avoiding AI with sufficient β-blocker treatment, and these patients may be good candidates for concomitant surgical intervention to a native AV at the time of LVAD implantation. (Int Heart J 2016; 57: 3-10)Key words: Pulsatility, VAD, Carvedilol, Aortic valve C urrently, the survival rate in patients with advanced heart failure (HF) has improved due to the development of continuous flow (CF) left ventricular assist device (LVAD) treatment and improvement of perioperative management procedures.1-9) However, quality of life during CF LVAD is still not satisfactory because of several unresolved postoperative complications. 4,10,11) One of the major complications is aortic insufficiency (AI), which is characterized as continuous aortic regurgitation during both systolic and diastolic phases through a degenerated and occasionally fusional native aortic valve (AV) ( Figure 1AB). 12,13) Native AV, which is apparently normal before LVAD implantation, can be associated with a considerable level of AI after LVAD implantation. Post-LVAD AI can develop even in the preoperative setting in which there is no aortic regurgitation at all. 12,14,15) In 2000, Rose, et al first documented acquired AV disease during pulsatile flow (PF) LVAD. They identified evidence of commissural fusion of native AV.16) In 2006, Frazier, et al summarized the relationship between commissural fusion of native AV and development of AI during CF LVAD treatment.17) We also showed that AI was more frequently observed in patients with CF LVAD as compared with PF pump in 2011 ( Figure 1C). 18) Since then, a number of single-center studies have documented a wide-ranging prevalence of AI during LVAD treatment. 15,[19][20][21] The development of AI during LVAD treatment is considered to be a multifactorial phenomenon and a result of altered AV and aortic root biomechanics due to chronic and continuous ventricular unloading. Unloading of LV results in ventricular decompression, and the combination of systolic ...

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Section: Preoperative β-Blocker Treatment and LV Reverse Remodeling (mentioning

confidence: 99%

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

Imamura

Kinugawa

2016

Int. Heart J.

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“…Type 1 collagen, type 1: type 3 collagen ratio, collagen cross linking and fibrosis have been shown to be elevated in a variety of clinical as well as experimental disease states (Avendano et al 1999;Badenhorst et al 2003;Marijianowski et al 1995;Mukherjee and Sen 1991;Porter and Turner 2009;Woodiwiss et al 2001). Reports of LVAD-induced ECM changes have been conflicting, with some revealing increased myocardial fibrosis and ECM volume following unloading (Klotz, S. et al 2005b;Li et al 2001;Matsumiya et al 2005;Saito et al 2010), and others showing a reduction (Akgul et al 2004;Bruckner et al 2001;Maybaum et al 2007;Thohan et al 2005;Thompson et al 2005). Bruggink et al demonstrated a biphasic response with initial expansion of ECM and then a subsequent regression with prolonged MU (Bruggink et al 2006).…”

Section: Extracellular Matrixmentioning

confidence: 99%

“…Matrix metalloproteinases (MMPs) are a group of enzymes responsible for collagen degradation and are tightly regulated by tissue inhibitors of metalloproteinases (TIMPs). HF is associated with large changes in MMP and TIMP action and thus ECM composition (Li et al 2001;Matsumiya et al 2005), and it is understood that altered regulation in their expression contributes to "negative" ECM remodelling in HF (Mann and Spinale 1998;Spinale et al 2000;Wilson and Spinale 2001). Normalisation (decrease) of MMP1:TIMP1 ratio has been reported with LVAD use in a DCM population and coincides with increased LV collagen cross linking, type 1: type 3 ratio and increased ventricular stiffness (Klotz,S et al 2005b).…”

Section: Extracellular Matrixmentioning

confidence: 99%

“…TIMP4 expression decreased in this study in contrast to previous studies showing unchanged/decreased MMP and augmented TIMP levels to coincide with LVAD support (Klotz,S et al 2005b;Li et al 2001). Levels of cardiac fibrosis (Matsumiya et al 2005;Saito et al 2010) and profibrotic marker gene expression (Felkin et al 2009) at time of LVAD implantation demonstrate predictive power with regards to likelihood of subsequent functional recovery, device explantability and durability of recovery. Negative ECM remodelling may represent a potentially important modifiable barrier to recovery in HF patients (Klotz, S. et al, 2007b).…”

Section: Extracellular Matrixmentioning

confidence: 99%

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Myocardial Recovery Following Left Ventricular Assist Device Therapy

Navaratnarajah¹,

Ibrahim²,

Yacoub³

et al. 2011

New Aspects of Ventricular Assist Devices

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“…5 However, there are only limited data about the long-term results of LVR in Japan. Furthermore, because of a specific situation related to the severely limited supply of organ donors and the limited availability of cardiac support devices, such as the ventricular assist system, 6 we have adopted liberal inclusion criteria for LVR, even for critically ill patients who are generally treated with mechanical circulatory support and subsequent heart transplantation. 7 Consequently, it is meaningful to examine our own experiences of LVR.…”

mentioning

confidence: 99%

Long-Term Results of Left Ventricular Reconstructive Surgery in Patients With Ischemic Dilated Cardiomyopathy

Takeda

Matsumiya

Sakaguchi

et al. 2008

Circ J

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urgical treatment of congestive heart failure associated with myocardial infarction (MI) is attracting much attention because its prognosis is still poor despite recent improvements in medical treatment. 1 Post-MI left ventricular (LV) remodeling is characterized by chamber dilatation and abnormal geometric change, which leads to heart failure progressing to ischemic cardiomyopathy. Heart transplantation is widely accepted as the optimal surgical therapy for heart failure patients, including those associated with ischemic etiology, but unfortunately transplantation is limited by the lack of donors and many exclusion criteria such as age and end-organ dysfunction. As an alternative surgical therapy, Dor at el introduced endoventricular circular patch plasty for patients with ischemic cardiomyopathy that has developed after a large anteroseptal MI. 2 Several modifications of LV restoration (LVR) have been proposed and some retrospective data, including largescale studies, have shown safety and efficacy in terms of survival benefit and LV functional recovery. 3,4 Moreover, there is an ongoing multicenter, randomized, international trial (Surgical Treatment for Ischemic Heart Failure trial) to elucidate the real benefits of LVR. 5 However, there are only limited data about the long-term results of LVR in Japan. Furthermore, because of a specific situation related to the severely limited supply of organ donors and the limited availability of cardiac support devices, such as the ventricular assist system, 6 we have adopted liberal inclusion criteria for LVR, even for critically ill patients who are generally treated with mechanical circulatory support and subsequent heart transplantation. 7 Consequently, it is meaningful to examine our own experiences of LVR.We conducted a multicenter retrospective study to analyze the long-term outcomes of LVR and examine its efficacy and limitations. Methods PatientsFour university-affiliated hospitals participated in the study. Ethical committee approval was obtained in each institution. We retrospectively reviewed 72 patients who underwent LVR from January 1999 to June 2007. All patients included in the analysis had preoperative global LV dysfunction (LV ejection fraction (EF) <40%) and significantly enlarged LV (end-systolic volume index (ESVI) Received April 18, 2008; revised manuscript received June 9, 2008; accepted June 17, 2008; released online September 18, 2008 Background Left ventricular restoration (LVR) is increasingly used for treatment of chronic heart failure following myocardial infarction. The present multi-institutional retrospective study analyzed the long-term efficacy and limitations of LVR. Methods and Results Seventy-two (58 males, mean age 62±10) patients who underwent LVR between January 1999 and June 2007 were included. Preoperatively, 50 (68.5%) were in New York Heart Association (NYHA) functional class III or IV. Mean left ventricular end-diastolic and end-systolic volume indexes were 145±43 ml/m 2 and 111±40 ml/m 2 , respectively, and ejection fraction...

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Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy?

Cited by 66 publications

References 22 publications

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

Myocardial Recovery Following Left Ventricular Assist Device Therapy

Long-Term Results of Left Ventricular Reconstructive Surgery in Patients With Ischemic Dilated Cardiomyopathy

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