Abstract 18067: Young Patients With Non-Ischemic Cardiomyopathy Have Higher Likelihood of Left Ventricular Recovery During HeartMate II Support: Data From the Bridge and Destination Therapy Trials
Background: Recovery of ventricular function during left ventricular assist device (LVAD) support sufficient to allow device explantation occurs infrequently, and underlying mechanisms remain poorly understood. Moreover, scarce data exists describing the patient profile most likely to exhibit sufficient LV recovery to allow explantation. We explored the hypothesis that certain patient profiles exists that are more likely to exhibit LV recovery during implantable mechanical support with a HMII LVAD.
Method: A retrospective review of data from the prospective multicenter for HMII bridge to transplant (BTT) and destination therapy (DT) trials was conducted encompassing 490 BTT, 600 DT, and 18 compassionate use patients.
Results: Of 1108 patients enrolled in the bridge and destination therapy HMII trials, 20 (1.8%) (10 BTT, 10 DT) were explanted for left ventricular recovery at 11 centers. Median age was 33 yrs and 55% were female. Fifteen of 20 pts (75%) were <45 yo. History of diagnosed heart failure was < 1 year for 13/20 (65%) of patients. Etiology was non-ischemic in 90%. Length of LVAD support prior to explant was 447±264 days. Three patients required reinstitution of mechanical support. Of these, one died, one was transplanted and one remains on HMII support. Among the 17 not reimplanted, 16 remain alive with their native heart. At latest follow up (median 658 days, 31.4 pt-yrs), mean EF for recovered patients was 42% (20–67%) and mean LVEDD was 53±9 mm. All available recovered patients (n=13) are currently in class I or II NYHA. Two-year reimplant-free and transplant-free survival was 85±8%.
Conclusions: Our data, which comprises the largest number of recovered patients with HMII to date, suggest that LV recovery, although occurring infrequently, is most likely to occur in patients with non-ischemic cardiomyopathy who are less than age 45 and have a less than 1 year history of diagnosed heart failure. Two-year transplant-free survival is excellent. It is important to perform rigorous testing for LV recovery in this patient profile.
- © 2010 by American Heart Association, Inc.