Pre-Explant Stability of Unloading-Promoted Cardiac Improvement Predicts Outcome After Weaning From Ventricular Assist Devices

• Published in: Circulation (New York, N.Y.) N.Y.), 2012-09, Vol.126 (11), p.S9-19
• Main Authors: DANDEL, Michael, YUGUO WENG, SINIAWSKI, Henryk, POTAPOV, Evgenij, KRABATSCH, Thomas, LEHMKUHL, Hans B, DREWS, Thorsten, KNOSALLA, Christoph, HETZER, Roland
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Agents - therapeutic use; Combined Modality Therapy; Device Removal; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Heart Failure - diagnostic imaging; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Failure - surgery; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart-Assist Devices; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - physiopathology; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Organ Size; Prognosis; Proportional Hazards Models; Recovery of Function; Recurrence; Retrospective Studies; Stroke Volume; Treatment Outcome; Ultrasonography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Young Adult
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.111.084640

Detection of cardiac recovery that allows long-term cardiac stability after ventricular assist device (VAD) explantation is a major goal. After normalization of ventricular diameters during unloading, the pre-explant left ventricular ejection fraction (LVEF) allows the detection of patients with the potential to remain stable after VAD explantation. However, some patients with LVEF >45 before VAD explantation show early recurrence of heart failure (HF). We aimed to find out if unstable improvement can be recognized before VAD explantation. Among 96 patients weaned from VADs since 1995, a relatively homogenous group of 53 patients with nonischemic chronic cardiomyopathy (CCM) was selected for the study. The pre-explant stability of major parameters of LV function, size, and geometry that were measured by echocardiography during serial "off-pump" trials was tested for relationship with cardiac stability after VAD explantation. LVEF, systolic peak wall motion velocity (Sm), end-diastolic diameter (LVEDD), end-diastolic relative wall thickness (RWT(ED)) and end-diastolic short/long-axis ratio (S/L(ED)) were selected for evaluation. In postweaning unstable patients, the selected parameters showed relevant instability already before VAD explantation during the time period between best cardiac improvement and VAD explantation and also during the final off-pump trial just before VAD explantation. For all parameters, there were significant differences (P