Document Detail


Hemodynamic changes during left ventricular assist device-off test correlate with the degree of cardiac fibrosis and predict the outcome after device explantation.
MedLine Citation:
PMID:  25370718     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Myocardial recovery occurs in a small cohort of patients receiving left ventricular assist device (LVAD) support, but identification of candidates for device removal remains challenging. We hypothesized that hemodynamic evaluation using echocardiography and right heart catheter during temporary suspension of LVAD support (LVAD-off test) can assess cardiac recovery to predict successful device removal. To prove this hypothesis, we reviewed 44 patients who underwent LVAD-off test from January 2000 to March 2011 at Osaka University Hospital. Twenty-two of them underwent LVAD explant, 9 showed sustaining recovery (successful explant, SE-group); whereas 13 had a recurrent heart failure (failed explant, FE-group). The other 22 patients remained LVAD dependent (nonrecovery, NR-group). Echocardiography showed significant lower ejection fraction (LVEF) in NR-group than in SE- and FE-group after termination of LVAD support, but there was no difference between SE- and FE-group. On the other hand, elevation in pulmonary capillary wedge pressure (ΔPCWP) was significantly smaller in SE-group than in FE- and NR-groups. The degree of cardiac fibrosis significantly increased in FE- and NR-group during the LVAD support, while it did not increase in SE-group. The degree of cardiac fibrosis at the time of LVAD explantation correlated significantly with PCWP at LVAD halt and ΔPCWP, and it had significant impact on the outcome after LVAD weaning. In conclusion, the data obtained during LVAD-off test using echocardiography and right heart catheter significantly correlated with the degree of cardiac fibrosis at the time of LVAD explantation. LVAD-off test is a useful method to predict the successful LVAD explantation.
Authors:
Shunsuke Saito; Koichi Toda; Shigeru Miyagawa; Yasushi Yoshikawa; Satsuki Fukushima; Yasushi Sakata; Isamu Mizote; Takashi Daimon; Yoshiki Sawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-5
Journal Detail:
Title:  Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs     Volume:  -     ISSN:  1619-0904     ISO Abbreviation:  J Artif Organs     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-5     Completed Date:  -     Revised Date:  2014-11-6    
Medline Journal Info:
Nlm Unique ID:  9815648     Medline TA:  J Artif Organs     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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