In a study presented today at the American Heart Association's Scientific Sessions 2004 in New Orleans, Marc A. Simon, M.D., fellow in transplantation cardiology at the University of Pittsburgh School of Medicine, reported on the long-term outcome of patients successfully weaned from VADs at the University of Pittsburgh Medical Center (UPMC).
"We found that seven percent of patients implanted with heart assist devices were successfully weaned from the devices without the need for a heart transplant," said Dr. Simon. "Our study found that when utilized in acute inflammatory cardiomyopathy or post-partum cardiomyopathy (PPCM), VAD support appears to allow long-term restoration of cardiac function. VAD support as a bridge to recovery (BTR) should be an important component of the care of acute inflammatory myocarditis."
The study included 147 patients who underwent VAD implantation at UPMC from 1996 through 2003. Of the patients, 70 were ischemic and 77 non-ischemic. Of these, 10 were weaned from VAD as a BTR.
They included two ischemic patients who needed heart bypass surgery following heart attacks and required postoperative VAD support. Both remain alive and transplant free.
A larger number of non-ischemic patients, eight, underwent successful BTR. Five received biventricular assist devices; three had a clinical course consistent with acute myocarditis; four had PPCM; and one had chronic non-ischemic cardiomyopathy with decompensation in the setting of active pulmonary tuberculosis, which was successfully treated while on VAD support.
After VAD removal, left ventricular function declined in two PPCM patients who required transplantation or repeat VAD support within one year. Left ventricular function remains normal in the 6 non-ischemic patients surviving transplant-free. Overall, 8 of 10 BTR patients (80 percent) are alive and free of transplant.
"With the availability of VADs, no patient should die from acute myocarditis or severe peripartum cardiomyopathy. This study demonstrates that ventricular support can facilitate dramatic recovery even in patients who are gravely ill," said Dennis McNamara, M.D., associate professor of medicine at the University of Pittsburgh School of Medicine and senior author of the study.
"Successful therapeutic strategies for end-stage congestive heart failure now include not only cardiac replacement with assist devices or transplantation, but the true opportunity for repair and recovery of myocardial function through the synergy between advanced medical therapy and ventricular assist devices," said Robert L. Kormos, M.D., director of Heart Transplantation, and director of the Artificial Heart Program at UPMC.
UPMC's Artificial Heart Program is one of the most experienced and active in the United States. Since its inception in 1985, the program has supported nearly 250 patients on assist devices for a period of time that equates to more than 50 years. It often serves as both a proving ground for manufacturers and a training center for surgeons from around the world. Devices that UPMC has used over the years include the Jarvik/Cardiowest Total Artificial Heart, Novacor Left Ventricular Assist Device (LVAD), Thoratec VAD and HeartMate I.