Key result
LVAD implantation in patients with decompensated end-stage peripartum cardiomyopathy resulted in 0% in-hospital mortality, 8.3% 1-year mortality, and successful LV recovery in one third.
Why the study?
Little is known about the long-term outcomes and prognosis of patients with peripartum cardiomyopathy undergoing LVAD implantation.
Does LVAD implantation improve survival and facilitate LV recovery in patients with decompensated end-stage peripartum cardiomyopathy?
Cohort (n=12)
Yes
Does LVAD implantation improve survival and facilitate LV recovery in patients with decompensated end-stage peripartum cardiomyopathy?
LVAD implantation is a feasible and effective strategy for decompensated end-stage peripartum cardiomyopathy, facilitating survival, bridge to transplant, and a high rate of myocardial recovery.
Answers are grounded in this paper and cite their sources.
LVAD use was associated with low mortality and recovery in peripartum cardiomyopathy; hypothesis-generating, requiring prospective confirmation before practice change.
BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF), presenting with left ventricular (LV) systolic dysfunction either at the end of pregnancy or in the months following delivery. In rare cases, PPCM leads to severe impairment of LV function, refractory cardiogenic shock or advanced HF. LV assist devices (LVAD) have been shown to be a feasible treatment option in advanced HF. However, little is known about long-term outcomes and prognosis of PPCM patients undergoing LVAD implantation. METHODS: A retrospective analysis of data from PPCM patients undergoing LVAD implantation in two tertiary centers with respect to long-term outcomes was performed. RESULTS: Twelve patients of median age 30 (18-39) years were included. Eight patients were experiencing cardiogenic shock (INTERMACS 1) at implantation. Seven patients were implanted within 1 month of their PPCM diagnosis. Median duration of LVAD support was 19 (2-92) months with median follow up of 67 (18-136) months (100% complete). In-hospital and 1-year mortality were 0% and 8.3%, respectively. Two patients died on LVAD support, four patients were successfully bridged to transplantation, two patients are still on LVAD, and four were successfully weaned due to sufficient LV recovery (one died after LV function deteriorated again). CONCLUSION: LVAD treatment of decompensated end-stage PPCM is feasible. Early LVAD provision led to hemodynamic stabilization in our cohort and facilitated safe LV recovery in one third of these young female patients.
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Berliner et al. (2022) conducted a cohort in Peripartum cardiomyopathy (PPCM) (n=12). Left ventricular assist device (LVAD) was evaluated on 1-year mortality. LVAD implantation in patients with decompensated end-stage peripartum cardiomyopathy resulted in 0% in-hospital mortality, 8.3% 1-year mortality, and successful LV recovery in one third.
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