Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices
Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices
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DOI：
10.1161/circulationaha.104.525352
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发表时间：
2005-08-30
期刊：
影响因子：
37.8
通讯作者：
Hetzer, R
中科院分区：
文献类型：
--
作者：
Dandel, M;Weng, YG;Hetzer, R
背景：自1995年我们首次在特发性扩张型心肌病（IDCM）患者中成功植入左心室辅助装置（LVAD）以来，我们科又有31例IDCM患者进行了脱机手术。超声心动图评估在重复的“无泵”试验是决定断奶的基础。经过9年的经验，我们根据长期结果评估了我们的断奶标准的可靠性。方法与结果：我们评估了1995年3月至2004年3月期间所有无LVAD支持的IDCM患者的心功能保存情况和脱机后的生存率。此外，我们回顾了我们的超声心动图数据，以评估其对断奶后心功能长期稳定性的预测价值。32例断奶的IDCM患者LVAD移植后5年生存率为78.3%+/- 8.1。心脏衰竭（HF）在断奶后的前3年内复发的占31.3%。仅有2例患者因脱机后心衰死亡；其余HF复发患者均移植成功。离泵左室舒张末期直径> 55 mm和/或LVAD移除前LVEF < 45%，以及LVAD植入前5年的HF病史>=早期HF复发的主要危险因素。没有这3种危险因素的患者在断奶后的前3年内没有HF复发，但同时，所有具有这3种危险因素中至少2种的患者都出现HF早期复发。在脱机后3年内HF复发的患者中，LVEF在脱机后的第一个月就已经出现了明显的下降，而在长期心功能稳定的患者中，即使在脱机后的第6个月结束时，LVEF也与移除LVAD前没有什么不同。结论：对于特定的IDCM患者，从LVAD中脱机是一种临床选择，在bb9年内效果良好，因此在LVAD植入后心脏恢复的患者中应该考虑。离泵超声心动图数据对于检测左室恢复和预测脱机后长期心脏稳定性是可靠的。
Background-Since our first successful left ventricular assist device (LVAD) explantation in a patient with idiopathic dilated cardiomyopathy (IDCM) in 1995, an additional 31 IDCM patients have been weaned in our department. Echocardiographic evaluations during repeated "off-pump" trials were the cornerstone for weaning decisions. After 9 years of experience, we assessed the reliability of our weaning criteria in light of the long-term results.Methods and Results-We evaluated all of the IDCM patients who were weaned between March 1995 and March 2004 with regard to preservation of cardiac function without LVAD support and survival after weaning. Additionally, we reviewed our echocardiographic data to assess their predictive value for long-term stability of cardiac function after weaning. The 32 weaned IDCM patients showed a survival rate of 78.3%+/- 8.1 at 5 years after LVAD explantation. Heart failure (HF) recurred during the first 3 years after weaning in 31.3%. Only 2 patients died because of HF after weaning; the other patients with HF recurrence were successfully transplanted. Off-pump LV end-diastolic diameter > 55 mm and/or LVEF < 45% before LVAD removal, as well as history of HF >= 5 years before LVAD implantation, appeared to be major risk factors for early recurrence of HF. Patients without any of these 3 risk factors showed no HF recurrence during the first 3 years after weaning, but at the same time, all of those with at least 2 of these 3 risk factors developed early recurrence of HF. In patients with HF recurrence during the first 3 postweaning years, a significant LVEF decrease already occurred during the first month after weaning, whereas in those with long-term stable cardiac function even at the end of the sixth postweaning month, the LVEF was not different from that before LVAD removal.Conclusions-For selected patients with IDCM, weaning from LVADs is a clinical option with good results over > 9 years and should, therefore, be considered in those with cardiac recovery after LVAD implantation. Off-pump echocardiographic data are reliable for the detection of LV recovery and prediction of long-term cardiac stability after weaning.