TY - JOUR
T1 - Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy
AU - Müller, Johannes
AU - Wallukat, Gerd
AU - Weng, Yu Guo
AU - Dandel, Michael
AU - Spiegelsberger, Susanne
AU - Semrau, Sabine
AU - Brandes, Kersten
AU - Theodoridis, Vassilis
AU - Loebe, Matthias
AU - Meyer, Rudolf
AU - Hetzer, Roland
PY - 1997/7/15
Y1 - 1997/7/15
N2 - 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-β1-adrenoceptor autoantibodies (A-β1-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-β1-AABs. Echocardiographic evaluation, serum tests for A-β1-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-β1-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-β1-AABs can be used to monitor myocyte recovery. Weaning from MCSS offers an alternative to cardiac transplantation in certain patients.
AB - 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-β1-adrenoceptor autoantibodies (A-β1-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-β1-AABs. Echocardiographic evaluation, serum tests for A-β1-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-β1-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-β1-AABs can be used to monitor myocyte recovery. Weaning from MCSS offers an alternative to cardiac transplantation in certain patients.
KW - Assist devices
KW - Cardiomyopathy
KW - Implantation
UR - http://www.scopus.com/inward/record.url?scp=0343765713&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0343765713&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.96.2.542
DO - 10.1161/01.CIR.96.2.542
M3 - Article
C2 - 9244223
AN - SCOPUS:0343765713
SN - 0009-7322
VL - 96
SP - 542
EP - 549
JO - Circulation
JF - Circulation
IS - 2
ER -