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Preoperative beta-blocker treatment is a key for deciding left ventricular assist device implantation strategy as a bridge to recovery

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  • Artificial Heart (Clinical)
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Abstract

To date, there have been few reports demonstrating preoperative predictors for left ventricular reverse remodeling (LVRR) after LV assist device (LVAD) implantation, especially among patients with dilated cardiomyopathy (DCM). We retrospectively analyzed 60 patients with stage D heart failure due to DCM who had received LVAD treatment [pulsatile flow (PF) type, 26; continuous flow type, 34]. Data were evaluated at 6 months or just before explantation of the LVAD. We defined “LV reverse remodeling” (LVRR) by the achievement of an LV ejection fraction (LVEF) of ≥35 % after 6 months of LVAD support or explantation of LVAD within 6 months. LVRR occurred in 16 of our patients (26.7 %). Uni/multivariate logistic regression analyses for LVRR demonstrated that of the preoperative variables evaluated, PF LVAD usage and insufficient preoperative β-blocker treatment were independent predictors for LVRR. Patients who accomplished LVRR had a better clinical course, including lower levels of aortic valve insufficiency and lower levels of plasma B-type natriuretic peptide. Of the six patients (10.0 %) in whom LVADs were eventually explanted, all had an LVEF of ≥35 % before explantation or at 6 months. Based on these results, we conclude that DCM patients with insufficient preoperative β-blocker treatment have a chance to achieve LVRR under LVAD support as a bridge to recovery.

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Acknowledgments

Grant-in-Aid from Fukuda Foundation for Medical Technology to K.K.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Teruhiko Imamura, Masaru Hatano, Takeo Fu**o, Hironori Muraoka, Toshiro Inaba & Hisataka Maki

  2. Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Koichiro Kinugawa & Shunei Kyo

  3. Department of Organ Transplantation, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Yukie Kagami & Miyoko Endo

  4. Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Osamu Kinoshita, Kan Nawata & Minoru Ono

Authors
  1. Teruhiko Imamura
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  2. Koichiro Kinugawa
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  3. Masaru Hatano
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Correspondence to Teruhiko Imamura or Koichiro Kinugawa.

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Imamura, T., Kinugawa, K., Hatano, M. et al. Preoperative beta-blocker treatment is a key for deciding left ventricular assist device implantation strategy as a bridge to recovery. J Artif Organs 17, 23–32 (2014). https://doi.org/10.1007/s10047-013-0748-7

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  • DOI: https://doi.org/10.1007/s10047-013-0748-7

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