{L}eft {V}entricular {A}ssist {D}evice and {D}rug {T}herapy for {T}he {R}eversal of {H}eart {F}ailure.

  • Birks E
  • Tansley P
  • Hardy J
 et al. 
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Abstract

In patients with severe heart failure,prolonged unloading of the myocardium
with the use of a left ventricular assist device has been reported
to lead to myocardial recovery in small numbers of patients for varying
periods of time. Increasing the frequency and durability of myocardial
recovery could reduce or postpone the need for subsequent heart transplantation.We
enrolled 15 patients with severe heart failure due to nonischemic
cardiomyopathy and with no histologic evidence of active myocarditis.
All had markedly reduced cardiac output and were receiving inotropes.
The patients underwent implantation of left ventricular assist devices
and were treated with lisinopril,carvedilol,spironolactone,and losartan
to enhance reverse remodeling. Once regression of left ventricular
enlargement had been achieved,the beta2-adrenergic-receptor agonist
clenbuterol was administered to prevent myocardial atrophy.Eleven
of the 15 patients had sufficient myocardial recovery to undergo
explantation of the left ventricular assist device a mean (+/-SD)
of 320+/-186 days after implantation of the device. One patient died
of intractable arrhythmias 24 hours after explantation; another died
of carcinoma of the lung 27 months after explantation. The cumulative
rate of freedom from recurrent heart failure among the surviving
patients was 100%and 88.9%1 and 4 years after explantation,respectively.
The quality of life as assessed by the Minnesota Living with Heart
Failure Questionnaire score at 3 years was nearly normal. Fifty-nine
months after explantation,the mean left ventricular ejection fraction
was 64+/-12%,the mean left ventricular end-diastolic diameter was
59.4+/-12.1 mm,the mean left ventricular end-systolic diameter was
42.5+/-13.2 mm,and the mean maximal oxygen uptake with exercise was
26.3+/-6.0 ml per kilogram of body weight per minute.In this single-center
study,we found that sustained reversal of severe heart failure secondary
to nonischemic cardiomyopathy could be achieved in selected patients
with the use of a left ventricular assist device and a specific pharmacologic
regimen.

Author-supplied keywords

  • Adolescent; Adrenergic beta-2 Receptor Agonists; A
  • Dilated
  • adverse effects; Humans; Male; Middle Aged; Oxygen
  • blood; Prospective Studies; Prosthesis Failure; Su
  • drug therapy/mortality/physiopathology/surgery; Ca
  • therapeutic use; Adult; Blood Pressure; Cardiac Ou
  • therapeutic use; Clenbuterol
  • therapeutic use; Combined Modality Therapy; Female

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Authors

  • Emma J Birks

  • Patrick D Tansley

  • James Hardy

  • Robert S George

  • Christopher T Bowles

  • Margaret Burke

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