Helman D N, Maybaum S W, Morales D L, Williams M R, Beniaminovitz A, Edwards N M, Mancini D M, Oz M C
Department of Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York 10032, USA.
Ann Thorac Surg. 2000 Oct;70(4):1255-8. doi: 10.1016/s0003-4975(00)01826-9.
Long-term left ventricular assist devices (LVAD) have been used both as a bridge to heart transplantation and to recovery of native myocardial function. Despite much evidence for reversal of some of the structural and functional changes present in the failing heart during LVAD support, clinical evidence for sustained myocardial recovery is scant. We describe 2 patients in whom myocardial recovery during LVAD support led to device explanation only to have heart failure recur. This necessitated a second LVAD implantation, a process that we have termed recurrent remodeling.
The medical records of 2 patients with cardiomyopathy supported with HeartMate LVADs (Thermo Cardiosystems, Inc, Woburn, MA) were retrospectively reviewed.
One patient was supported with an LVAD for 2 months, at which time the LVAD was explanted. Progressive deterioration of cardiac function followed, requiring a second LVAD 19 months after LVAD explanation. After 2 months of further LVAD support, a second episode of apparent myocardial recovery was observed during a period of device malfunction. The other patient was supported with an LVAD for 12 months, at which time the LVAD was explanted. The patient experienced progressive hemodynamic deterioration and required a second LVAD 6 months after LVAD explantation. Heart transplantations of both patients were successful.
Our understanding of myocardial recovery in the setting of hemodynamic unloading with LVAD support has not yet progressed to the point where we are able to accurately predict successful long-term LVAD explantation. The evolution of reliable predictors of sustainable myocardial recovery will help to avoid further cases of recurrent remodeling requiring repeat LVAD implantation.
长期左心室辅助装置（LVAD）已被用作心脏移植的桥梁以及促进天然心肌功能恢复的手段。尽管有大量证据表明在LVAD支持期间，衰竭心脏中存在的一些结构和功能变化可得到逆转，但关于心肌持续恢复的临床证据却很少。我们描述了2例患者，他们在LVAD支持期间心肌恢复导致装置移除，但随后心力衰竭复发。这使得有必要再次植入LVAD，我们将这一过程称为反复重塑。
对2例接受HeartMate LVAD（美国马萨诸塞州沃本市热控心血管系统公司）支持的心肌病患者的病历进行回顾性分析。
1例患者接受LVAD支持2个月后移除LVAD。随后心功能逐渐恶化，在移除LVAD 19个月后需要再次植入LVAD。在进一步接受LVAD支持2个月后，在装置故障期间观察到第二次明显的心肌恢复。另1例患者接受LVAD支持12个月后移除LVAD。该患者出现进行性血流动力学恶化，在移除LVAD 6个月后需要再次植入LVAD。2例患者的心脏移植均成功。
我们对在LVAD支持下血流动力学卸载情况下心肌恢复的理解尚未达到能够准确预测LVAD长期成功移除的程度。可靠的可持续心肌恢复预测指标的发展将有助于避免更多需要重复植入LVAD的反复重塑病例。
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