Abstract 17811: Rate of Cardiac Recovery with Combined Pharmacological Therapy and Continuous Flow LVAD Support
Introduction: Bridge to recovery has remained a tantalizing option for LVAD therapy despite disappointing rates of cardiac improvement in the literature. Most of these prior studies were limited by lack of adjuvant heart failure medical therapy (HFMED) or were reported in the first generation pulsatile pumps. We assessed the hypothesis that frequent visits for uptitration of HFMED in continuous flow (CF) LVAD recipients would lead to cardiac recovery in a meaningful proportion of patients.
Methods: Since 2006 we have defined all non-ischemics (DCM) and acute ischemics (CAD) as our recovery population. These recipients are seen biweekly for protocol driven up-titration of HFMED to a target MAP of 70mmHg. One month after achieving maximal tolerated HFMED, cardiac function is assessed by echocardiogram with an LVAD-weaned study where LVAD flow is reduced to an assumed net-zero flow of 6200rpm for 15 minutes.
Results: Between June 2006 and January 2011, 70 patients received a CF LVAD at our institution and 30 formed our recovery population. Of these, 4 died and 5 went to transplant prior to reaching HFMED while 3 were excluded because of complications that occurs during LVAD support. Data from the remaining 18 (60%) formed the study cohort. Five (17%) subjects demonstrated normalization of biventricuclar size and function (Table 1) and 3 (10%) went on to device explantation after further study. Duration of HF tended to be shorter in the recovered patients.
Conclusions: In our experience, utilizing frequent follow-up for aggressive uptitration of HFMED, 17% of CF LVAD patients with DCM or acute CAD could be managed to complete recovery. Further investigation of this approach is warranted.
- © 2011 by American Heart Association, Inc.