Left Ventricular Assist Device Can Reverse Heart Failure
Most patients have device removed within one year
THURSDAY, Nov. 2 (HealthDay News) -- Many patients with severe heart failure secondary to non-ischemic cardiomyopathy could be treated effectively and see regression of their disease with the use of a left ventricular assist device, according to a report in the Nov. 2 New England Journal of Medicine.
Emma J. Birks, M.R.C.P., Ph.D., of the Royal Brompton and Harefield National Health Service Trust in Middlesex, U.K., and colleagues implanted a left ventricular assist device in 15 patients with severe heart failure due to non-ischemic cardiomyopathy. Patients were treated with lisinopril, carvedilol, spironolactone and losartan to enhance reverse remodeling, followed by a beta-agonist after regression occurred.
Eleven of the patients had sufficient myocardial recovery to allow explantation of the device at an average of 320 days after surgery. While two patients died -- one immediately after surgery from an intractable heart rhythm and one later from a lung carcinoma -- 100 percent of the surviving patients were free of heart failure at one year. Four years later, 89 percent were still free of disease.
"The treatment of stage D heart failure now includes more than end-of-life strategies, transplantation and permanent implantation of left ventricular assist devices," according to Dale G. Renlund, M.D., and Abdallah G. Kfoury, M.D., of the Utah Transplantation Affiliated Hospitals, in an accompanying editorial. "Indeed, left ventricular assist devices may sustain therapies that enable reverse remodeling, improve myocardial energetics and prepare the heart for removal of the device."
Some of the authors received grants from Thoratec, the manufacturer of the HeartMate left ventricular assist device used in the study.