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99: Is native cardiac recovery sustainable following successful ventricular assist device support in cardiogenic shock post acute myocardial infarction?
The Journal of Heart and Lung Transplantation Volume 26, Number 2S
Abstracts
of heart failure in the HM II group (14%) compared to those in the HM XVE group (50%). Mean BSA was lower in the HM II group (1.6⫾0.2 vs. 2.0⫾0.1; p⫽0.07). All patients required inotropic support. Two patients in the HM II group were ineligible for IABP support because of size. One (33%) in the HM II group and 2 (50%) patients in the HM XVE group received IABP support pre-operatively. Baseline biochemical markers were not significantly different in both groups (sodium 128⫾6 vs. 134⫾5 mmol/L; creatinine 1.1⫾0.3 vs. 1.5⫾0.1 mg/dl; hematocrit 31⫾4 vs. 33⫾9 %; and albumin 3.5⫾0.4 vs. 3.4⫾0.4 g/dl, respectively. p⫽NS for all). Patients in both groups had normal biochemical markers on discharge. There was a significantly shorter post-operative length of stay for patients in the HM II group compared to those in the HM XVE group (28⫾7 vs. 49⫾10, p ⫽ 0.048). Conclusions: The small axial flow LVAD in heart failure patients as a bridge to transplant is associated with a reduced length of postoperative hospitalization compared to the use of the large pulsatile flow LVAD. 98 LONG TERM SUPPORT WITH CONTINUOUS FLOW LVAD: EFFECT OF REDUCED PULSATILITY ON RENAL FUNCTION M.S. Slaughter,1 M.A. Sobieski,1 C. Gallagher,2 M. Dia,3 M.A. Silver,3 1Cardiovascular Surgery, Advocate Christ Medical Center, Oak Lawn, IL; 2Cardiovascular Research, Cardiac Surgery Clinical Research Center, Inc, Oak Lawn, IL; 3Cardiology, Advocate Christ Medical Center, Oak Lawn, IL Purpose: The acute and long term effects of continuous flow LVADs and diminished pulsatility in patients with impaired renal function remains a clinical concern when evaluating patients for Destination Therapy (DT). Methods and Materials: We evaluated 10 patients with moderately impaired renal function implanted with the Heartmate II continuous flow LVAD for DT. The LVAD was managed to maximize LV unloading resulting in minimal to no pulse pressure with a minimum of 9 months follow-up. Results: There were 8 men and 2 women with a preoperative median VO2 of 9.65 (range 7.9 – 11.6) and an average support time of 352 days. The pre-op median Cr was 1.5 (range 1.0 – 2.4), BUN 26.2 (range 17 - 59) and creatinine clearance (CrCL) of 33.6 (range 24.1 – 69.7). Six patients had a CrCL ⬍ 35 (range 24 – 35). Postoperatively the Cr peaked on POD#3 and returned to baseline by POD#7. The Cr showed improvement between 30 days and 6 months which was sustained out to one year. Conclusions: Long term support with a continuous flow LVAD and reduced pulsatility had no adverse effect in patients with renal dysfunction. Moderate impairment of renal function is not a contraindication for a continuous flow LVAD in DT patients.
S95
M. Anderson,1 M. Madani,2 Y. Naka,3 D. Raess,4 L. Samuels,5 B. Sun,6 1Department of Cardiac Surgery, Robert Wood Johnson, New Brunswick, NJ; 2Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA; 3Department of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; 4Department of Cardiothoracic Surgery, St. Francis Hospital, Indianapolis, IN; 5Department of Cardiothoracic Surgery, Lankenau Medical Science Hospital, Philadelphia, PA; 6 Department of Cardiothoracic Surgery, Ohio State University Medical Center, Columbus, OH Purpose: The role of the Ventricular Assist Device (VAD) as a bridge-to-transplant technology has been well documented in the treatment of Cardiogenic Shock (CS) post Acute Myocardial Infarction (AMI). However, transplantation is related to high costs, complications, and constrained by donor availability. Few studies have examined the feasibility of long-term native heart recovery for these patients after successful initial VAD support. We report a multicenter US experience that demonstrates sustainable cardiac recovery for AMI CS patients implanted with a VAD. Methods and Materials: This study enrolled 50 patients at 26 US centers who were implanted with the AB5000 VAD (ABIOMED, Inc.) after aggressive therapies failed to restore hemodynamics post-AMI CS. Pre implant conditions included inotropes 100%, IABP 88%, arrhythmia 71%, hypercreatineamia 52%, and hyperbilirubinemia 50%. Bi-ventricular support was required in 48% of the patients. Results: The overall 30-day survival rate was 42% (n⫽21). Of those who survived, restoration of native cardiac function was reported in 71% (n⫽15). Of the patients with native heart recovery at discharge and with known follow-up outcome at 1 year post-VAD explant (n⫽12), 75% were still alive, demonstrating sustained cardiac recovery. Conclusions: Unassisted cardiac function post-AMI CS is feasible after AB5000 VAD support. This recovery is sustainable, suggesting the VAD should be used primarily to bridge patients to recovery after aggressive therapies fail to reverse refractory CS.
LVAD Renal Function 100 Baseline POD #3 POD #7 30 Days 6 Months 1 Year Flow Flow Index Speed Pulse Pressure BUN Creatinine
3.4 1.8 N/A 22 26.4 1.5
5.15 2.65 9400 17 32.3 1.77
5.59 2.8 9200 18 25.3 1.4
5.25 2.7 9200 23 22.3 1.2
5.42 2.8 9400 14 22.9 1.3
5.7 2.9 10000 16 22.3 1.3
99 IS NATIVE CARDIAC RECOVERY SUSTAINABLE FOLLOWING SUCCESSFUL VENTRICULAR ASSIST DEVICE SUPPORT IN CARDIOGENIC SHOCK POST ACUTE MYOCARDIAL INFARCTION?
CLINICAL EXPERIENCE WITH THE AB5000 AS A BRIDGE-TOTRANSPLANT VAD: SUCCESSFUL CROSS-OVER FOR EXTENDED BRIDGE-TO-RECOVERY PATIENTS J. Elefteriades,1 M. Madani,2 A.J. Crumbley,3 D. Adams,4 M. Anderson,5 1Department of Cardiothoracic Surgery, Yale University Medical Center, New Haven, CT; 2Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA; 3Cardiovascular Surgery, Medical University of South Carolina, Charleston, SC; 4Department of Thoracic Surgery, Mount Sinai Medical Center, New York, NY Purpose: Patients in acute cardiogenic shock requiring full support should be given the opportunity for bridge-to-recovery (BTR) of their
Abstracts
of heart failure in the HM II group (14%) compared to those in the HM XVE group (50%). Mean BSA was lower in the HM II group (1.6⫾0.2 vs. 2.0⫾0.1; p⫽0.07). All patients required inotropic support. Two patients in the HM II group were ineligible for IABP support because of size. One (33%) in the HM II group and 2 (50%) patients in the HM XVE group received IABP support pre-operatively. Baseline biochemical markers were not significantly different in both groups (sodium 128⫾6 vs. 134⫾5 mmol/L; creatinine 1.1⫾0.3 vs. 1.5⫾0.1 mg/dl; hematocrit 31⫾4 vs. 33⫾9 %; and albumin 3.5⫾0.4 vs. 3.4⫾0.4 g/dl, respectively. p⫽NS for all). Patients in both groups had normal biochemical markers on discharge. There was a significantly shorter post-operative length of stay for patients in the HM II group compared to those in the HM XVE group (28⫾7 vs. 49⫾10, p ⫽ 0.048). Conclusions: The small axial flow LVAD in heart failure patients as a bridge to transplant is associated with a reduced length of postoperative hospitalization compared to the use of the large pulsatile flow LVAD. 98 LONG TERM SUPPORT WITH CONTINUOUS FLOW LVAD: EFFECT OF REDUCED PULSATILITY ON RENAL FUNCTION M.S. Slaughter,1 M.A. Sobieski,1 C. Gallagher,2 M. Dia,3 M.A. Silver,3 1Cardiovascular Surgery, Advocate Christ Medical Center, Oak Lawn, IL; 2Cardiovascular Research, Cardiac Surgery Clinical Research Center, Inc, Oak Lawn, IL; 3Cardiology, Advocate Christ Medical Center, Oak Lawn, IL Purpose: The acute and long term effects of continuous flow LVADs and diminished pulsatility in patients with impaired renal function remains a clinical concern when evaluating patients for Destination Therapy (DT). Methods and Materials: We evaluated 10 patients with moderately impaired renal function implanted with the Heartmate II continuous flow LVAD for DT. The LVAD was managed to maximize LV unloading resulting in minimal to no pulse pressure with a minimum of 9 months follow-up. Results: There were 8 men and 2 women with a preoperative median VO2 of 9.65 (range 7.9 – 11.6) and an average support time of 352 days. The pre-op median Cr was 1.5 (range 1.0 – 2.4), BUN 26.2 (range 17 - 59) and creatinine clearance (CrCL) of 33.6 (range 24.1 – 69.7). Six patients had a CrCL ⬍ 35 (range 24 – 35). Postoperatively the Cr peaked on POD#3 and returned to baseline by POD#7. The Cr showed improvement between 30 days and 6 months which was sustained out to one year. Conclusions: Long term support with a continuous flow LVAD and reduced pulsatility had no adverse effect in patients with renal dysfunction. Moderate impairment of renal function is not a contraindication for a continuous flow LVAD in DT patients.
S95
M. Anderson,1 M. Madani,2 Y. Naka,3 D. Raess,4 L. Samuels,5 B. Sun,6 1Department of Cardiac Surgery, Robert Wood Johnson, New Brunswick, NJ; 2Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA; 3Department of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; 4Department of Cardiothoracic Surgery, St. Francis Hospital, Indianapolis, IN; 5Department of Cardiothoracic Surgery, Lankenau Medical Science Hospital, Philadelphia, PA; 6 Department of Cardiothoracic Surgery, Ohio State University Medical Center, Columbus, OH Purpose: The role of the Ventricular Assist Device (VAD) as a bridge-to-transplant technology has been well documented in the treatment of Cardiogenic Shock (CS) post Acute Myocardial Infarction (AMI). However, transplantation is related to high costs, complications, and constrained by donor availability. Few studies have examined the feasibility of long-term native heart recovery for these patients after successful initial VAD support. We report a multicenter US experience that demonstrates sustainable cardiac recovery for AMI CS patients implanted with a VAD. Methods and Materials: This study enrolled 50 patients at 26 US centers who were implanted with the AB5000 VAD (ABIOMED, Inc.) after aggressive therapies failed to restore hemodynamics post-AMI CS. Pre implant conditions included inotropes 100%, IABP 88%, arrhythmia 71%, hypercreatineamia 52%, and hyperbilirubinemia 50%. Bi-ventricular support was required in 48% of the patients. Results: The overall 30-day survival rate was 42% (n⫽21). Of those who survived, restoration of native cardiac function was reported in 71% (n⫽15). Of the patients with native heart recovery at discharge and with known follow-up outcome at 1 year post-VAD explant (n⫽12), 75% were still alive, demonstrating sustained cardiac recovery. Conclusions: Unassisted cardiac function post-AMI CS is feasible after AB5000 VAD support. This recovery is sustainable, suggesting the VAD should be used primarily to bridge patients to recovery after aggressive therapies fail to reverse refractory CS.
LVAD Renal Function 100 Baseline POD #3 POD #7 30 Days 6 Months 1 Year Flow Flow Index Speed Pulse Pressure BUN Creatinine
3.4 1.8 N/A 22 26.4 1.5
5.15 2.65 9400 17 32.3 1.77
5.59 2.8 9200 18 25.3 1.4
5.25 2.7 9200 23 22.3 1.2
5.42 2.8 9400 14 22.9 1.3
5.7 2.9 10000 16 22.3 1.3
99 IS NATIVE CARDIAC RECOVERY SUSTAINABLE FOLLOWING SUCCESSFUL VENTRICULAR ASSIST DEVICE SUPPORT IN CARDIOGENIC SHOCK POST ACUTE MYOCARDIAL INFARCTION?
CLINICAL EXPERIENCE WITH THE AB5000 AS A BRIDGE-TOTRANSPLANT VAD: SUCCESSFUL CROSS-OVER FOR EXTENDED BRIDGE-TO-RECOVERY PATIENTS J. Elefteriades,1 M. Madani,2 A.J. Crumbley,3 D. Adams,4 M. Anderson,5 1Department of Cardiothoracic Surgery, Yale University Medical Center, New Haven, CT; 2Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA; 3Cardiovascular Surgery, Medical University of South Carolina, Charleston, SC; 4Department of Thoracic Surgery, Mount Sinai Medical Center, New York, NY Purpose: Patients in acute cardiogenic shock requiring full support should be given the opportunity for bridge-to-recovery (BTR) of their