Midterm follow-up of patients who underwent removal of a left ventricular assist device after cardiac recovery from end-stage dilated cardiomyopathy

Objective: Cardiac recovery in end-stage idiopathic dilated cardiomyopathy recently occurred after temporary support with a left ventricular assist de vice. We report the case histories of patients who underwent removal of the device more than 4 years ago. Methods: Since June 1994, 23 patients with end-stage idiopathic dilated car diomyopathy who were supported by a left ventricular assist device or biven tricular assist device for 1 to 26 months (mean, 6 months) underwent remova l of the device after complete or extensive cardiac recovery, as revealed b y echocardiography. Results: Seven patients (group A) had recurrent cardiac failure after 4 to 24 months. Transplantation was performed in 6 patients, and one died while on the waiting list. Three patients died of noncardiac causes within a peri od of 4 months and 3 days after removal of the assist device. Stable cardia c recovery occurred in 13 patients (group B) for 3 to 49 months (mean, 23 m onths). At the time of implantation, there were no significant differences between the groups with regard to age, hemodynamics, left ventricular eject ion fraction, left ventricular internal diameter in diastole, and autoantib ody levels. The increase of ejection fraction and the decrease of left vent ricular internal diameter in diastole after 2 months were highly significan t. The patients in group A had longer histories of heart failure and first cardiac symptoms and duration of assist when compared with group B. Group B demonstrated a quicker cardiac recovery on the assist device, and thus sup port was shorter. Also, the degree of recovery at assist device explantatio n was more complete in group B. The age at the time of device placement was the only influencing factor for duration on the assist device. The probabi lity of recurrence of heart failure was influenced by the duration of heart failure. Conclusions: In selected patients with idiopathic dilated cardiomyopathy, l asting recovery can be achieved after unloading with a left ventricular ass ist device. Lasting cardiac recovery seems to be related to functional norm alization and a more rapid recovery during the unloading period.