LVADs: Bridges to transplant or recovery?
Some CHF patients can return to normal’
Some patients with congestive heart failure (CHF) can be safely weaned off their temporary implanted pumping devices, a new study reports.1
The devices were meant as interim stopgaps, or bridges, until heart transplants could be arranged. Those few patients are able to survive without undergoing the cost and risks of their anticipated heart transplant.
Left ventricular assist devices (LVAD) were originally designed to keep CHF patients alive until a donor heart became available. However, researchers now report findings that five out of 111 transplant candidates — 4.5% of patients — who received LVADs could successfully be weaned off the device and survive for up to two years without it. And those are patients who had presumably irreversible end-stage heart failure, mostly dilated cardiomyopathy, a condition in which the heart becomes enlarged and pumps blood inefficiently.
The study may show that, with careful screening and use of adjunctive therapies, heart function seemingly can be dramatically modified and returned nearly to normal for short periods. Hearts in failure "still possess tissue that can be restored to normal or near-normal function," wrote one investigator.
The findings suggest that perhaps CHF can be reversed rather than just managed, the report authors wrote. An accompanying editorial points out technological improvements in LVADs will make them an alternative to transplant for many patients with advanced heart failure who cannot receive transplants or who cannot be weaned from the devices.2
Today, the high cost and risks associated with implanting LVADs preclude its use in many patients.
References
1. Mancini DM, Beniaminovitz A, Levin H, et al. Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure. Circulation 1998; 98:2,383-2,389.
2. Mann DL, Willerson JT. Left ventricular assist devices and the failing heart: A bridge to recovery, a permanent assist device, or a bridge too far? Circulation 1998;98: 2,367-2,369.
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