Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure

Djordje G. Jakovljevic, Magdi H. Yacoub, Stephan Schueler, Guy A. MacGowan, Lazar Velicki, Petar M. Seferovic, Sandeep Hothi, Bing Hsiean Tzeng, David A. Brodie, Emma Birks, Lip Bun Tan

Research output: Contribution to journalArticlepeer-review

88 Scopus citations

Abstract

Background Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery. Objectives This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls. Methods Fifty-eight male patients—18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)—and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O2 consumption. Results All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O2 consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls. Conclusions The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.

Original languageEnglish
Pages (from-to)1924-1933
Number of pages10
JournalJournal of the American College of Cardiology
Volume69
Issue number15
DOIs
StatePublished - Apr 18 2017

Bibliographical note

Publisher Copyright:
© 2017 The Authors

Keywords

  • LVAD
  • cardiac power
  • exercise capacity
  • heart transplant
  • recovery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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