Key result
Bridge-to-recovery LVAD strategy linked to ~9-fold higher cardiac recovery versus non-BTR approaches.
Why the study?
Does an a priori bridge-to-recovery strategy increase the incidence of cardiac recovery in LVAD recipients compared to a non-BTR strategy?
Cohort (n=15,138)
Yes
Does an a priori bridge-to-recovery strategy increase the incidence of cardiac recovery in LVAD recipients compared to a non-BTR strategy?
Answers are grounded in this paper and cite their sources.
An a priori bridge-to-recovery strategy and specific favorable baseline characteristics (identified by the I-CARS score) are associated with a significantly higher probability of successful cardiac recovery and LVAD explantation.
BACKGROUND: The number of centers with left ventricular assist device (LVAD) research programs focused on cardiac recovery is very small. Therefore, this phenomenon has been reported in real-world multi-center registries as a rare event. OBJECTIVES: This study evaluated the incidence of cardiac recovery with an a priori LVAD implantation strategy of bridge-to-recovery (BTR) and constructed a recovery predictive model. METHODS: The study included LVAD recipients registered in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Cardiac recovery was evaluated in BTR and non-BTR patients. A weighted score was derived and externally validated in patients of the Utah Cardiac Recovery (UCAR) program. RESULTS: Of 15,138 INTERMACS patients, cardiac recovery occurred in 192 (1.3%). The incidence of recovery was 11.2% (n = 14) in BTR compared with 1.2% (n = 178) in non-BTR patients (p < 0.0001). Independent predictors of recovery included: age <50 years, non-ischemic cardiomyopathy, time from cardiac diagnosis <2 years, absence of ICD, creatinine ≤1.2 mg/dl, and LVEDD <6.5 cm (c-index: 0.85; p < 0.0001). A weighted score termed I-CARS, effectively stratified patients based on their probability of recovery. I-CARS was validated in the UCAR cohort (n = 190) with good performance (AUC: 0.94; 95% CI: 0.91 to 0.98). One-year survival after LVAD explantation, available in INTERMACS for 21 (11%) patients, was 86%. CONCLUSIONS: The incidence of cardiac recovery is higher in patients implanted with an a priori BTR strategy. We developed a simple tool to help identify patients in whom recovery is feasible. In BTR patients with favorable characteristics, I-CARS suggests a 24% probability of successful LVAD explantation. Large-scale studies to better address post-explantation outcomes are warranted.
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Wever‐Pinzon et al. (2016) conducted a cohort in Left ventricular assist device (LVAD) recipients (n=15,138). Bridge-to-recovery (BTR) LVAD implantation strategy vs. Non-BTR LVAD implantation strategy was evaluated on Incidence of cardiac recovery (p=<0.0001). An a priori bridge-to-recovery LVAD implantation strategy was associated with a significantly higher incidence of cardiac recovery compared with non-BTR strategies (11.2% vs 1.2%; p<0.0001).
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