Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy

被引:3
|
作者
Muller, J [1 ]
Wallukat, G [1 ]
Weng, YG [1 ]
Dandel, M [1 ]
Spiegelsberger, S [1 ]
Semrau, S [1 ]
Brandes, K [1 ]
Theodoridis, V [1 ]
Loebe, M [1 ]
Meyer, R [1 ]
Hetzer, R [1 ]
机构
[1] MAX DELBRUCK CTR MOL MED, BERLIN, GERMANY
关键词
cardiomyopathy; assist devices; implantation;
D O I
暂无
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Implantation of mechanical cardiac support systems (MCSS) in patients with idiopathic dilated cardiomyopathy (IDC) may improve cardiac function and allow explantation of the device. We report of long-term effects of ventricular unloading on cardiac function, humoral anti-beta 1-adrenoceptor autoantibodies (A-beta(1)-AABs), and myocardial fibrosis. Methods and Results Seventeen patients in New York Heart Association functional class IV with nonischemic IDC received MCSS. All had a cardiac index of <1.6 L.min(-1).m(-2) of body surface area, a left ventricular ejection fraction (LVEF) of <16%, and a left ventricular internal diameter in diastole (LVIDd) of >68 mm and tested positive for A-beta(1)-AABs. Echocardiographic evaluation, serum tests for A-beta(1)-AABs, and histological assessment of myocardial fibrosis were performed before and after MCSS implantation. The mean support duration was 230+/-201 days. Six patients died, four were transplanted, and two are still on MCSS. Five patients with significant cardiac recovery (mean LVIDd, 54+/-2.3 mm; LVEF, 47+/-3.7%) were weaned after 160 to 794 days and are now device free for 51 to 592 days. A-beta(1)-AABs disappeared gradually during MCSS without increase after weaning; cardiac function and volume density of fibrosis remained normal. Nine patients' cardiac function hardly improved during ventricular unloading. Conclusions Cardiac function can be normalized in selected patients with end-stage IDC by MCSS. The degree of preoperative myocardial fibrosis may be an indicator for outcome; A-beta(1)-AABs can be used to monitor myocyte recovery. Weaning from MCSS offers an alternative to cardiac transplantation in certain patients.
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页码:542 / 549
页数:8
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