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September 1, 1998ASAIO Journal

Systolic function improved in all 6 patients; 2 patients showed remarkable decrease in LVDd, were successfully weaned after 3 months, and survived >1 and >3 years with peak VO2 levels of 30 and 27 ml/min/kg.

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Why the study?

Does long-term LVAS improve cardiac function and allow for weaning in patients with end-stage cardiomyopathy?

Population

6 heart transplant candidates, aged 17 to 49, with dilated cardiomyopathy.

Design

Case_series

Follow-up

Up to >3 years after LVAS removal

Authors

TNTakeshi NakataniYSYoshikado SasakoJKJunjiro Kobayashi

Discussion

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Overview

May support weaning after LVAS in select end-stage cardiomyopathy cases; hypothesis-generating and requires prospective validation before broader adoption.

Key Points

  • To evaluate whether long-term left ventricular assist system support can promote native myocardial recovery and allow device weaning in end-stage cardiomyopathy.
  • Implanted a paracorporeal left ventricular assist system (LVAS) between the left atrium and ascending aorta in 6 heart transplant candidates (aged 17–49) with dilated cardiomyopathy.
  • Maintained pump flow rates at 4 to 5 L/min, introduced exercise post-stabilization, and serially monitored cardiac dimensions and function via echocardiography.
  • Systolic ejection time improved in all 6 patients during mechanical circulatory support.
  • Left ventricular end-diastolic dimension significantly decreased in 2 patients, permitting successful device weaning after 3 months with sustained functional capacity (peak VO2 of 30 mL/min/kg at 1.2 years and 27 mL/min/kg at 2.7 years post-explantation).
  • The remaining 4 patients showed no marked ventricular dimension changes; 3 remained device-dependent and 1 was discontinued after 5 months due to infection and died 2 months post-explantation.

Structured PICO

Does long-term LVAS improve cardiac function and allow for weaning in patients with end-stage cardiomyopathy?

P
Population
6 heart transplant candidates, aged 17 to 49, with dilated cardiomyopathy (including one dilated phase hypertrophied cardiomyopathy).
I
Intervention
Long-term left ventricular assist system (LVAS) installed between the left atrium and the ascending aorta, with paracorporeal pump positioning, maintaining pump flows at 4 to 5 L/min.
O
Outcome
Recovery of natural heart size and function (systolic function and left ventricular end-diastolic dimension) measured by echocardiography.surrogate

Long-term LVAS support can promote reverse remodeling and recovery of native heart function in a subset of patients with end-stage cardiomyopathy, allowing for successful device weaning.

Cite This Study

Nakatani et al. (1998) studied this question.

synapsesocial.com/papers/6a8a89b9ec2e105e8ac151a5https://doi.org/10.1097/00002480-199809000-00039
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Implantable electrical left ventricular assist systems: Bridge to transplantation and future1989 · 215 citations
  2. 2Myocardial Size and Fibrosis Changes During Left Ventricular Assist Device Support2012 · 17 citations
  3. 3Implantable Left Ventricular Assist Systems (LVAS): Recent Results. A Report from a Series of Meetings Sponsored by the Study Group on Advanced Heart Failure of the Working Group on Heart Failure2000 · 6 citations
  4. 4Recovery of Myocardial Function with Long-Term Ventricular Assist Device Support2001 · 5 citations
  5. 5Recovery of Dilated Cardiomyopathies in Infants and Children Using Left Ventricular Assist Devices2010 · 29 citations