Journal of Artificial Organs

, Volume 17, Issue 1, pp 23–32 | Cite as

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

  • Teruhiko Imamura
  • Koichiro Kinugawa
  • Masaru Hatano
  • Takeo Fujino
  • Hironori Muraoka
  • Toshiro Inaba
  • Hisataka Maki
  • Yukie Kagami
  • Miyoko Endo
  • Osamu Kinoshita
  • Kan Nawata
  • Shunei Kyo
  • Minoru Ono
Original Article Artificial Heart (Clinical)

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.

Keywords

Heart failure Ejection fraction Recovery Continuous flow 

Notes

Acknowledgments

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

Conflict of interest

None.

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Copyright information

© The Japanese Society for Artificial Organs 2013

Authors and Affiliations

  • Teruhiko Imamura
    • 1
  • Koichiro Kinugawa
    • 2
  • Masaru Hatano
    • 1
  • Takeo Fujino
    • 1
  • Hironori Muraoka
    • 1
  • Toshiro Inaba
    • 1
  • Hisataka Maki
    • 1
  • Yukie Kagami
    • 3
  • Miyoko Endo
    • 3
  • Osamu Kinoshita
    • 4
  • Kan Nawata
    • 4
  • Shunei Kyo
    • 2
  • Minoru Ono
    • 4
  1. 1.Department of Cardiovascular Medicine, Graduate School of MedicineUniversity of TokyoBunkyo-ku, TokyoJapan
  2. 2.Department of Therapeutic Strategy for Heart Failure, Graduate School of MedicineUniversity of TokyoBunkyo-ku, TokyoJapan
  3. 3.Department of Organ Transplantation, Graduate School of MedicineUniversity of TokyoTokyoJapan
  4. 4.Department of Cardiothoracic Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan

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