Craig H. Selzman, MD, Jesse L. Madden, MD, Aaron H

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Presentation transcript:

Bridge to Removal: A Paradigm Shift for Left Ventricular Assist Device Therapy Craig H. Selzman, MD, Jesse L. Madden, MD, Aaron H. Healy, MD, Stephen H. McKellar, MD, Antigone Koliopoulou, MD, Josef Stehlik, MD, MPH, Stavros G. Drakos, MD, PhD The Annals of Thoracic Surgery Volume 99, Issue 1, Pages 360-367 (January 2015) DOI: 10.1016/j.athoracsur.2014.07.061 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Bridge to removal. A left ventricular assist device (LVAD) is placed in patients with pathologic remodeling and development of advanced heart failure. After implantation, the heart undergoes variable levels of reverse remodeling. If inadequate (nonresponder), then continued support or transplantation remain the mainstay of therapy. If cellular, metabolic, architectural, and functional reversal occurs to normal, these patients exhibit myocardial recovery. Another, perhaps more common, group are patients who demonstrate functional improvement without structural or molecular normalization. These latter two groups (in orange) are both considered responders to therapy and are candidates for consideration of LVAD removal. The Annals of Thoracic Surgery 2015 99, 360-367DOI: (10.1016/j.athoracsur.2014.07.061) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Highest left ventricular ejection fraction (LVEF) achieved after left ventricular assist device (LVAD). (A) Highest LVEF achieved after LVAD unloading. (B) Changes in LVEF over time with highest LVEF achieved 30% to 39% (group 3). (C) Changes in LVEF over time for patients with highest LVEF achieved greater than 40% (group 4). Data are percentages, means, and confidence intervals. *p < 0.01 versus before LVAD. (Reproduced from Drakos et al [17] with permission.) The Annals of Thoracic Surgery 2015 99, 360-367DOI: (10.1016/j.athoracsur.2014.07.061) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Apical closure without plug. (A) Intraoperative view demonstrates primary closure associated with removal of the Jarvik 2000 Flowmaker left ventricular assist device. The polypropylene suture is seen as it goes through felt strips that include the flexible sewing ring. (B) Primary closure with felt strips is shown after removal of the rigid HeartWare sewing ring. Note the arterial cannula in the transected outflow graft. The Annals of Thoracic Surgery 2015 99, 360-367DOI: (10.1016/j.athoracsur.2014.07.061) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions