The Heart Can Heal Itself, Sometimes

Implanted device removed safely in 32 would-be transplant patients, report says

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By Ed Edelson
HealthDay Reporter

MONDAY, Aug. 29, 2005 (HealthDay News) -- The equivalent of a miracle can happen for some people with heart failure so severe that they have a pump implanted to keep them alive long enough for a transplant, German cardiologists report.

Sometimes the heart just gets better and stronger so that the implanted device can be removed and no transplant is necessary, claim doctors at Deutsches Herzzentrum Berlin.

The implanted pump is a left ventricular assist device (LVAD). It is put into the abdomen to keep blood flowing when the heart can no longer do the job properly.

Ordinarily, the LVAD comes out only after a heart transplant. But 32 people with the most severe form of heart failure, idiopathic dilated cardiomyopathy, were successfully taken off the pump and have thrived, the report said.

And the recovery appears to be indefinitely long, said Dr. Michael Dandel, a cardiologist who is the lead author of the report. "Even 10 years does not appear to be the upper limit," he said. "Our first three weaned patients are still asymptomatic and show no alteration of cardiac function after 10 years."

The findings appear in the Aug. 30 issue of Circulation.

The condition that leads to implantation of an LVAD includes abnormal enlargement of the heart's left ventricle, which pumps blood to the body. But sometimes there is a remarkable reduction in the size of the heart after the device is implanted.

There's no way to tell in advance which patients will eventually be fit enough to have the LVAD removed, the report said. The answer comes from continued surveillance using ultrasound examinations.

The primary criteria to determine whether the device can safely be removed are satisfactory heart function when the LVAD is turned off briefly; heart failure that has lasted no longer than five years; normal heart rhythm; normal blood pressure; and absence of severe heart valve problems, the report said.

Dr. Michael K. Banbury, a cardiac surgeon at The Cleveland Clinic Foundation, whose work includes implanting LVADs, said he has seen the same thing happen in some of his patients, and that other cardiac centers in the United States have reported similar incidents.

"But they have a lot of patients," Banbury said of the German report. "Thirty-two patients with dilated cardiomyopathy. That is probably the largest series ever reported."

Banbury let a shade of doubt enter his appraisal of the report. "They [the German doctors] didn't do anything in particular to make patients eligible" for the study, he said. "It makes you wonder how sick the patients were."

Still, the report offers some consolation for heart failure patients who are told their chance for survival depends on a transplant, Banbury said. "There is always hope," he said.

As for which patients will be able to have their LVADs removed safely, Banbury added, "Luck never hurts."

More information

For more on dilated cardiomyopathy, visit the American Heart Association.

SOURCES: Michael Dandel, M.D., cardiologist, Deutsches Herzzentrum Berlin, Germany; Michael K. Banbury, M.D., cardiac surgeon, The Cleveland Clinic Foundation, Ohio; Aug. 30, 2005, Circulation

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