Outcomes from a recovery protocol for patients with continuous-flow left ventricular assist devices
Section snippets
Methods
The standard evaluation protocol at our center consists of 3 consecutive steps (refer to Figure 2). This study is a retrospective analysis of the data of all patients who underwent the evaluation process between January 2016 and April 2018. The study was reviewed and approved by the ethics commission at Charité University. Because this was a retrospective study, informed consent from the patients was not required.
Results
Between January 2016 and April 2018, 424 patients with LVADs (279 HeartWare HVAD, 52 HeartMate II, and 93 HeartMate 3) were screened as a first step in our outpatient department. Thirty-three (7.8%) patients went into second-step evaluation (20 males, 13 females). Patients were supported with either HeartWare HVAD (n = 23), HeartMate II (n = 2), or HeartMate 3 (n = 8) devices. Implantations were performed between August 2010 and August 2017. The mean time between implantation and baseline
Discussion
In this study we have presented a retrospective analysis of the weaning protocol developed at the German Heart Center Berlin for assessment of myocardial recovery and weaning from CF-LVAD (Figure 2). The patients who entered the first step of assessment were “all-comers” from an outpatient department. Only a small proportion of our LVAD population was regarded as suitable for elective weaning (7.8%). This concurs with international registries and other retrospective studies.15, 16, 17
Disclosure statement
V.F. is a member of the medical boards of Abbott, Medtronic, and Berlin Heart, and a principal investigator for ZH Heart. T.K. reports grants from Abbott and Medtronic and honoraria for working as a proctor for Abbott and Medtronic. E.P. reports grants from Abbott and Medtronic and honoraria as a proctor for Abbott and Medtronic. The remaining authors have no conflicts of interest to disclose. We thank Anne Wölffel-Gale for editorial assistance.
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2023, Journal of Heart and Lung TransplantationCitation Excerpt :A further 3 patients underwent explantation even though they had a pulmonary capillary wedge pressure above 20 mm Hg. This is much higher than the cut-off suggested by us and other groups.3,8,10,11 Our data are, of course, limited and only sufficient to generate hypotheses.
Experience with a standardized protocol to predict successful explantation of left ventricular assist devices
2022, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :The Institutional Review Board waived the need for informed written consent for publication of the study data. The protocol for elective LVAD explantation consists of 3 consecutive steps (Figure 1) and has been described.14 All outpatients who presented at our center underwent electrocardiography, a clinical assessment, and echocardiography.
Global best practices consensus: Long-term management of patients with hybrid centrifugal flow left ventricular assist device support
2022, Journal of Thoracic and Cardiovascular SurgeryLeft Ventricular Hemodynamics and Relationship With Myocardial Recovery and Optimization in Patients Supported on CF-LVAD Therapy
2022, Journal of Cardiac FailureCitation Excerpt :A multitude of positive effects occur on the myocardium after LVAD implantation, which include cardiac myocyte tubule regeneration, restoration of calcium cycling, cytoskeletal reorganization, improved signaling, and even cardiomyocyte cellular regeneration,20,21 although macrostructural changes have not been demonstrated consistently.22 Some changes, such as a decrease in the LVEDd may occur early within the first 3 months after implantation, but the degree of long-term recovery also depends on distribution of age and etiology of cardiomyopathy of the patient population undergoing implantation; thus, some experiences have been enriched with patients likely to recover.9,11 The association between enhanced recovery and neurohormonal blockade therapy had been previously suggested by retrospective studies (including the data shown herein), but was impressively shown in the recent RESTAGE-HF trial.10