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(Circulation. 2005;112:I-32 – I-36.)
© 2005 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Myocardial Recovery Using Ventricular Assist Devices

Prevalence, Clinical Characteristics, and Outcomes

Marc A. Simon, MD; Robert L. Kormos, MD; Srinivas Murali, MD; Pradeep Nair, MD; Michael Heffernan, BS; John Gorcsan, MD; Stephen Winowich, BS, ChE; Dennis M. McNamara, MD, MS

From the Cardiovascular Institute (M.A.S., S.M., J.G., D.M.M.), Division of Cardiothoracic Surgery (R.L.K.), Department of Medicine (P.N.), Artificial Heart Program (S.W.), School of Medicine (M.H.), and McGowan Institute for Regenerative Medicine (R.L.K., S.M., D.M.M.), University of Pittsburgh Medical Center, Pittsburgh, Pa.

Correspondence to Dennis M. McNamara, MD, Director, Heart Failure/Transplantation Program, University of Pittsburgh Medical Center, 566 Scaife Hall, 200 Lothrop St, Pittsburgh, PA. E-mail mcnamaradm{at}upmc.edu

Background— Ventricular assist devices (VADs) are important bridges to cardiac transplantation. VAD support may also function as a bridge to ventricular recovery (BTR); however, clinical predictors of recovery and long-term outcomes remain uncertain. We examined the prevalence, characteristics, and outcomes of BTR subjects in a large single center series.

Methods and Results— We implanted VADs in 154 adults at the University of Pittsburgh from 1996 through 2003. Of these implants, 10 were BTR. This included 2/80 (2.5%) ischemic patients (supported 42 and 61 days, respectively). Both subjects had surgical revascularization, required perioperative left VAD support, and were alive and transplant-free at follow up (232 and 1319 days, respectively). A larger percentage of nonischemic patients underwent BTR (8/74, 11%; age 30±14; 88% female; left ventricular ejection fraction 18±6%; supported 112±76 days). Three had myocarditis, 4 had post-partum cardiomyopathy (PPCM), and 1 had idiopathic cardiomyopathy. Five received biventricular support. After explantation, ventricular function declined in 2 PPCM patients who then required transplantation. Ventricular recovery in the 6 nonischemic patients surviving transplant-free was maintained (left ventricular ejection fraction 54±5%; follow-up 1.5±0.9 years). Overall, 8 of 10 BTR patients are alive and free of transplant (follow-up 1.6±1.1 years).

Conclusions— In a large single center series, BTR was evident in 11% of nonischemic patients, and the need for biventricular support did not preclude recovery. For most BTR subjects presenting with acute inflammatory cardiomyopathy, ventricular recovery was maintained long-term. VAD support as BTR should be considered in the care of acute myocarditis and PPCM.

Key Words: heart-assist device • heart failure • transplantation • cardiomyopathy • myocarditis