Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure

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  2. Dr Djordje Jakovljevic
  3. Dr Guy MacGowan
Author(s)Jakovljevic DG, Yacoub MH, Schueler S, MacGowan AG, Velicki L, Seferovic PM, Hothi S, Tzeng BT, Brodie DA, Birks EJ, Tan LB
Publication type Article
JournalJournal of the American College of Cardiology
ISSN (print)0735-1097
ISSN (electronic)1558-3597
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Background: Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy or in some patients as a bridge-to-recovery. Objective: The present study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls. Methods: Fifty-eight male patients, 18 implanted with a continuous flow LVAD, 16 LVAD explanted (recovered) patients and 24 heart transplant candidates (HTx), and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) haemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure x cardiac output) and functional capacity by peak exercise O2 consumption. Results: All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD compared with other patients (healthy, 5.35±0.95; explanted, 3.45±0.72; LVAD implanted, 2.37±0.68; HTx, 1.31±0.31 watts, p<0.05), as was peak O2 consumption (healthy, 36.4±10.3; explanted, 29.8±5.9; implanted, 20.5±4.3; HTx, 12.0±2.2 ml.kg.min-1, p<0.05). In the LVAD explanted group 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls. Conclusion: We have shown for the first time that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.
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