N. Moazami et al., INFLOW VALVE REGURGITATION DURING LEFT-VENTRICULAR ASSIST DEVICE SUPPORT MAY INTERFERE WITH REVERSE VENTRICULAR REMODELING, The Annals of thoracic surgery, 65(3), 1998, pp. 628-631
Citations number
25
Categorie Soggetti
Surgery,"Cardiac & Cardiovascular System","Respiratory System
Background. Left ventricular assist devices have been reported previou
sly to reverse ventricular remodeling in patients with dilated cardiom
yopathy. In patients with prolonged mechanical support, structural fai
lure of the left ventricular assist device inflow valve can cause regu
rgitation into the left ventricle, which may affect adversely this pro
cess. Methods. Left ventricular end-diastolic pressure-volume relation
of hearts explanted from 8 patients with left ventricular assist devi
ce and 8 control subjects with idiopathic cardiomyopathy was determine
d ex vivo at the time of transplantation. Results. Duration of mechani
cal support ranged from 210 to 276 days (mean +/- standard deviation =
283 +/- 76 days) in 3 patients with inflow valve regurgitation versus
100 to 155 days (132 +/- 22 days) in 5 patients without (p = 0.005).
The end-diastolic pressure-volume relation of all hearts supported mec
hanically was shifted to the left toward normal controls, This effect
was markedly attenuated in patients with inflow valve regurgitation. C
onclusions. Mechanical assistance can cause reverse remodeling in pati
ents with dilated cardiomyopathy as evidenced by the shift in the end-
diastolic pressure-volume relation curve to the left. inflow valve fai
lure, associated with prolonged support, can attenuate changes in left
ventricular structure and dimension, Ineffective pressure and volume
unloading may explain these observations. (C) 1998 by The Society of T
horacic Surgeons.