1. Ventricular function recovery on LVAD For idiopathic or ischemic CM
P. Leprince,
CT Surgery
Institut of cardiology
Pitié-Salpétrière Group
Paris, France

2. Intermacs
1.4%

3. Intermacs
0.8%
0.9%
0.4% 1%
16%
0.3%

4. Hetzer R

5. Hetzer R

6. Hetzer R

7. Circulation. 2008;118[suppl 1]:S94–S105.
Hetzer R

8. * 30<LVEF<44% at 55<LVEDD<66mm before VAD removal
Hetzer R

10. 15 patients
The patients underwent implantation of left ventricular assist devices and were treated with
lisinopril,
carvedilol,
spironolactone,
and losartan to enhance reverse remodeling.
Once regression of left ventricular enlargement had been achieved, the β2-adrenergic–receptor agonist clenbuterol was administered to prevent myocardial atrophy.

11. 11 patients explanted, 1 death

15. Conclusions
LVAD removal should be considered as contraindicated if off-pump LVEF does not exceed 40%.
Patients with a history of HF of 5 years should be monitored very carefully after weaning
Neither the LVIDd nor the LVEF measured before LVAD implantation are predictive for potential myocardial improvement during mechanical unloading.

16. Weaning rate: 8.8%
Multivariate analysis: risk factor for sustained recovery
Age: OR 1.036
Pulsatile: OR (19.4% vs 2.46%)

17. 14 BTR, 29 BTT, 29 Tx J Heart Lung Transplant 2008;27:165–72
SF-36: Physical, mental, Global

18. HMII and Myocardial recovery in ischemic CM
P. Leprince,
Institut de cardiologie
Chirurgie Cardiovasculaire
Groupe Hospitalier Pitié-Salpétrière
Paris

19. Medical History 51 years old female Smoker Regular physical activity
March 14th:
Fast run to get the bus
Pain, Collapsed, spontaneous quick recovery
March 15th:
Family practitioner: normal exam, normal EKG
March 16 and 17th:
Dyspnea, fatigue

20. March 18: Pain recurrence, collapse Emergency room BP: 95/50
Persisting pain
Heart rate : 110
TTE: extented akinesia (anterior and lateral wall, apex, septum). EF: < 25%
 Dobutamine

22. After PTCA Dobutamine 10 mic IAPB BP 90 Pic troponin: 42
Stable biologie
Clinical signs of poor peripheral perfusion after few hours
ECMO

24. No recovery after 10 days

25. To test for potential recovery To buy time before transplantation
HMII Implantation instead of high emergency list cardiac transplantation
To test for potential recovery
To buy time before transplantation

26. After implantation Good general status recovery
Discharged directly to home after 20 days
Echocardiography:
Good LV unloading
No aortic valve opening
Myocardial contraction slightly better

27. Follow up No complication Good quality of life
New Echocardiography in June

29. Vacation time 8000 rpm

30. Explantation: September

31. Follow-up

32. > 5 years Doing well on ACE inhinbitor and beta bloquers
Normal life
Back to physical activies
Disappearance of apical clot
Isotopic EF: 60%

33. 5 ischemic patients /55 HMII patients
3 males, 2 females
Age: 39 to 54
All with
cardiogenic shock related to AMI
ECMO + IABP + inotropes 6 to 10 days
EF at implantation: 7 to 25%
B-, ACE Inhib, Aldactone
Weaning process started at 4 to 14 months
Weaned at 7 to 21 months (EF 25 to 55%)
1 death related to septic shock

34. Conclusion Recovery does exist (5 to 10%)
Every patient should be treated and screened for it
Young age and short duration of heart failure are favorable factors for sustained recovery
Role of pulsatility?
Another advocacy for early implantation