Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
Can J Cardiol. 2011 May-Jun;27(3):358-62. doi: 10.1016/j.cjca.2011.01.005.
Ventricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre.
Patients who had a VAD explanted were identified in the mechanical support institutional database and their outcomes were analyzed. Clinical examinations, biochemical markers, and serial echocardiograms were used to demonstrate myocardial recovery.
Seventeen patients had a Heartmate II VAD inserted between 2008 and 2010. Four patients underwent successful weaning and subsequent VAD explantation. Etiology of decompensated heart failure was idiopathic dilated cardiomyopathy (n = 1), ischemic (n = 1), or myocarditis (n = 2). Mean age was 35.3 years. Patients were supported for 213 days (range 70-293 days) and were in New York Heart Association class I in the community before explantation. The devices were explanted via a minimally invasive approach, without cardiopulmonary bypass. All patients survived explantation and were discharged alive from hospital after an average of 5.7 ± 1.5 days post pump explantation. No adverse events were reported after explantation. Only one patient required allogenic blood transfusion after the procedure.
Patients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.
心室辅助装置（VAD）用于治疗对药物治疗无反应的心力衰竭。大多数 VAD 用作心脏移植的桥接；然而，在某些情况下，心肌功能恢复，患者脱机后可以取出 VAD。本研究的目的是描述在四级心脏中心需要插入 Heartmate II VAD 后心肌恢复并取出的患者。
在机械支持机构数据库中确定插入 VAD 的患者，并分析其结局。临床检查、生化标志物和连续超声心动图用于证明心肌恢复。
17 例患者在 2008 年至 2010 年间插入 Heartmate II VAD。4 例患者成功脱机并随后取出 VAD。失代偿性心力衰竭的病因是特发性扩张型心肌病（n=1）、缺血性（n=1）或心肌炎（n=2）。平均年龄为 35.3 岁。患者接受支持 213 天（范围 70-293 天），在取出 VAD 前在社区中处于纽约心脏协会心功能 I 级。通过微创方法，在无体外循环的情况下取出设备。所有患者均在取出后存活，平均在泵取出后 5.7±1.5 天出院。取出后无不良事件报告。只有 1 例患者在手术后需要异体输血。
需要 VAD 支持心肌衰竭的患者可以进行显著的逆重构。取出可导致最小的发病率和最佳的结局。评估逆重构的方法、脱机方案和最佳取出时机仍在评估中。
