Document Detail


Left ventricular assist device therapy in patients with restrictive and hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  21303989     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular assist device (LVAD) is being increasingly used in patients with end-stage dilated and ischemic cardiomyopathy. There have been no clinical trials addressing the use of LVAD therapy in patients with end-stage heart failure caused by restrictive (RCM) or hypertrophic cardiomyopathy (HCM). The purpose of this study was therefore to analyze the outcome of LVAD therapy in these patients.
METHODS AND RESULTS: Eighty-three patients received continuous axial flow LVAD (Heart mate II, Thoratec, Pleasanton, CA) from February 2007 to May 2010 at our institution. We analyzed the baseline characteristics and surgical and long-term impact of LVAD therapy in 8 patients with RCM or HCM and compared their outcomes with the 75 patients with dilated and ischemic cardiomyopathy. Compared with patients with ischemic or dilated cardiomyopathy, patients with RCM and HCM have significantly smaller left ventricular end-diastolic dimensions (52.5±6 mm versus 68.6±8 mm; P<0.0001) and increased thickness of septal (16 [12, 19] mm versus 10[8.5, 11] mm, P=0.0003) and higher left ventricular ejection fraction (21 [20, 36]% versus 17 [15, 22]%; P=0.0009). We found no difference in early mortality (12.5% versus 9.3%, P=0.57) or length of hospital stay (11 [8, 45] days versus 18.5 [12.2, 27.7] days; P=0.51) between the 2 groups. The right atrial pressure was higher (18 [15, 20] mm Hg versus 12 [9, 15] mm Hg, P=0.03), and pump flow was lower (4.3 [3.8, 4.5] L versus 5.2 [4.7, 5.5] L, P=0.001) after LVAD implantation in patients with RCM and HCM. Central venous catheter related infections were more common in patients with RCM and HCM (87.5% versus 44.5%, P=0.006). There was no difference in the total number of blood units transfused. Median (min, max) follow-up duration after LVAD implantation was 166 [1, 1044] days. The 1-year actuarial survival rate was not different between the 2 groups (87.5% [95% confidence interval, 52.9% to 97.8%] versus 73.2 [95% confidence interval, 60% to 85%]; P=0.77).
CONCLUSIONS: Our preliminary data show that patients with end-stage heart failure caused by RCM or HCM may benefit from continuous axial flow LVAD therapy. This small study suggests that mortality is comparable with those patients who have dilated or ischemic cardiomyopathy, but right heart failure, prolonged inotropic use, and central venous catheter infections are more common in patients with RCM and HCM who were treated with LVAD. Because of the small numbers the differences should be interpreted cautiously, and prospective clinical trials would be required to recommend this therapy for these patients as bridge to transplantation or destination treatment.
Authors:
Yan Topilsky; Naveen L Pereira; Dipesh K Shah; Barry Boilson; John A Schirger; Sudhir S Kushwaha; Lyle D Joyce; Soon J Park
Related Documents :
6271839 - Treatment of human spasticity with delta 9-tetrahydrocannabinol.
20923869 - Altered cardiovascular responses to tracheal intubation in patients with complete spina...
2805369 - Laryngeal electromyography: a useful technique for the investigation of vocal cord palsy.
15121229 - Spindle cell carcinoma of the larynx.
8501489 - Cardiac dysfunction following spinal irradiation during childhood.
16235699 - Clinical experience using incubated autologous macrophages as a treatment for complete ...
23219829 - Positron emission tomography findings in children with infantile spasms and autism.
16702469 - Impact of completeness of percutaneous coronary intervention revascularization on long-...
10500789 - Mrp expression in acute myeloid leukemia. an update.
Publication Detail:
Type:  Journal Article     Date:  2011-02-08
Journal Detail:
Title:  Circulation. Heart failure     Volume:  4     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-18     Completed Date:  2011-07-14     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  266-75     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Cardiomyopathy, Hypertrophic / complications,  surgery*
Cardiomyopathy, Restrictive / complications,  surgery*
Female
Heart Failure / etiology,  surgery*
Heart Ventricles
Heart-Assist Devices*
Humans
Male
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Snake bites in Moyen Chari district, Chad: a five-year experience.
Next Document:  Visual distortion of body size modulates pain perception.