Optimized LVAD Mechanical Unloading May Reverse Heart Failure
High rate of patients meet criteria for explantation with LVAD mechanical unloading plus pharmacologic treatment
WEDNESDAY, Oct. 28, 2020 (HealthDay News) -- An optimized left ventricular assist device (LVAD) mechanical unloading, combined with standardized specific pharmacologic therapy, can help patients reach criteria for explantation within 18 months, according to a study published online Oct. 26 in Circulation.
Emma J. Birks, M.D., Ph.D., from the University of Kentucky in Lexington, and colleagues enrolled 40 patients with chronic advanced heart failure from nonischemic cardiomyopathy receiving the Heartmate II LVAD to examine whether a protocol of optimized LVAD mechanical unloading, combined with standardized specific pharmacologic therapy to induce reverse remodeling and regular testing of underlying myocardial function, could produce a high incidence of LVAD explantation.
The researchers found that 40 percent of enrolled patients (16 patients) achieved the primary end point of sufficient improvement of myocardial function to reach criteria for explantation within 18 months with sustained remission from heart failure (freedom from transplant, VAD, death) at 12 months, and 50 percent of the patients receiving the protocol (18 of 36) were explanted within 18 months. Nineteen patients were explanted overall. Postexplantation survival free from LVAD or transplantation was 90 and 77 percent at one year and at two and three years, respectively.
"These results are important because myocardial recovery and remission from heart failure would be the preferred outcome, if the patient can retrain their own heart over heart transplant or permanent LVAD support," the authors write.
The study was funded by Thoratec, which is now Abbott Medical.