Abstract 9540: Time-Course of Cardiac Improvement During Mechanical Unloading Predicts Outcome After Weaning From Ventricular Assist Devices
Background: Detection of cardiac improvement which allows long-term transplant-free outcome after weaning from ventricular assist devices (VADs) is a major goal. In patients with normalization of left ventricular (LV) diameters during unloading, the pre-explantation “off-pump” LVEF allows the distinction between patients with and without the potential to remain stable after weaning. However, some patients with LVEF > 45% before VAD removal show early recurrence of heart failure (HF). We assessed this aspect and aimed to find out if unstable improvement can already be recognized before VAD removal.
Methods: Among 94 patients weaned from VADs since 1995, a homogenous group of 46 patients with non-ischemic chronic cardiomyopathy (CCM) was selected for the evaluation of ECHO data obtained during serial “off-pump” trials before VAD explantation.
Results: In the evaluated patients, post-weaning 10-year survival without HF recurrence reached 66.0 ± 7.6%. In patients with LV end-diastolic diameter (LVEDD) ≤ 55mm and LVEF ≥ 45% at the time of VAD removal, pre-explantation stability of LVEF and/or LVEDD (no or less than 10% alteration in comparison to the best of all off-pump values until VAD removal) showed a 94.1% predictive value for cardiac stability during the first 5 post-weaning years. Pre-explantation alterations of LVEF with > 10% of best “off-pump” values or a decrease of > 10% of the LV end-diastolic relative wall thickness (RWT) during the final off-pump trials in patients with pre-explantation LVEF of between 45% and 50% showed predictive values of 87.5% and 83.3%, respectively, for HF recurrence during the first 3 post-weaning years. The stability of LV systolic wall motion peak velocity (Sm) during off-pump trials and between the detection of maximum cardiac improvement and time of VAD removal also appeared predictive for 5 year post-weaning stability. Patients needing > 6 months for LVEF improvement to ≥ 45% showed 79.1% probability for HF recurrence during the first 3 years.
Conclusions: The pre-explantation time-course of LVEF, LVEDD, RWT and Sm is predictive for the long-term post-weaning stability of unloading-induced cardiac recovery. Assessment of these parameters during serial off-pump trials can improve weaning decisions in CCM patients.
- © 2011 by American Heart Association, Inc.