Recovery of natural heart function in severe heart failure patients by long term circulatory support with ventricular assist system

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Extracorporeal National Cardiovascular Center type left ventricular assist systems (LVASs) were applied to 35 cardiomyopathy patients who were considered to be candidates for heart transplantation aged younger than 60 years old. Of those, 30 patients were suffered from dilated cardiomyopathy, 4 from ischemic cardiomyopathy and 1 for dilated phase of hypertrophic cardiomyopathy. Implantation of LVAS was performed when patient condition was deteriorated in spite of massive medical and/or surgical treatments. Five of 35 patients were needed right heart support due to profound right heart failure. In 30 cases with LVAS support without right heart support, initial 10 cases were implanted left atrial drainage type LVAS(LA). In recent cases, left ventricular drainage type LVAS(LV) were implanted. Mean assist duration was 165 days in LA type and was 367 days, including ongoing 8 cases, in LV type. All cases were stabilized after application of LVAS. Rehabilitation was started and administrations of beta-blockers and ACE inhibitors were performed. Natural cardiac function was tested by echocardiography periodically and weaning from LVAS was tried when natural heart function showed recovery of its function. In LA type, 3 out of 10 cases showed recovery of their natural heart function and LVASs were removed after 3-5 months support. All three cases are doing well 2.5-6.8 years after removal under outpatient clinic. In 20 LV type supports, only 4 cases showed recovery of natural heart. In one case, removal from LVAS was performed followed by reimplantation of LVAS due to acute deterioration of natural heart function. In seven cases (LA: 2, LV: 5), heart transplantation was done after 330 days supports on average. Their excised hearts showed severe destruction of myocardial tissue. Difference between LA type and LV type in effects of cardiac function and evaluation of natural heart function under LVAS support were studied.