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Ann Thorac Surg 1999;68:734-741
© 1999 The Society of Thoracic Surgeons

Alternatives To Transplantation

Left ventricular assist system as a bridge to myocardial recovery

O.H. Frazier, MDa, Timothy J. Myers, BSa

a Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas, USA

Address reprint requests to Dr Frazier, Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345
e-mail: mmallia{at}heart.thi.tmc.edu

Presented at the Fourth International Conference on Circulatory Support Devices for Severe Cardiac Failure, The Society of Thoracic Surgeons, Houston, TX, Oct 3–5, 1997.

Abstract

Background. Despite recent advances in medical therapy, heart transplantation, and mechanical circulatory support, the mortality of patients with congestive heart failure remains high.

Methods. Retrospective data on 5 patients were obtained from our hospital’s medical records. Each patient was supported by a left ventricular assist system (LVAS) because of severe congestive heart failure. The duration of LVAS support averaged 229 days (range, 46 to 447 days). In 3 patients, the LVAS was removed electively after the patient showed recovery of myocardial function. In the other 2, it was removed because of a malfunction.

Results. In response to LVAS support, hemodynamic variables were significantly improved. The mean cardiac index increased from 1.45 to 2.69 L · min-1 · m-2 (p < 0.001) and the mean left ventricular ejection fraction increased from 0.144 to 0.288 (p < 0.025). All patients were in New York Heart Association functional class IV at LVAS implantation and class I at its explantation. One patient died of noncardiac-related causes 10 days after LVAS removal. The remaining 4 patients are alive and well 35, 33, 14, and 2 months after LVAS removal.

Conclusions. In select patients with severe congestive heart failure, mechanical unloading with an LVAS can result in recovery of myocardial function. These patients can return to a normal physical status, thereby avoiding heart transplantation. More research is required to determine optimal modes of LVAS support, to predict which patients are likely to recover, and to assess long-term outcomes.




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