Mounting
evidence exists to support the hypothesis that the temporary
use of VAD systems may allow for
recovery of native heart
function. At UPMC, no longer does the VAD implant necessitate
the need for a heart transplant. Routine physiological testing.
and cardiac catheterizations can be coupled with novel non-invasive
“weaning trials” to determine who may be a candidate
for VAD removal.
In the past, recovery candidates were thought to be limited to post-cardiotomy VAD implants. At UPMC, the team has successfully weaned VAD patients afflicted with post-partum, viral cardiomyopathies and even ischemic heart disease.
Specific to UPMC Presbyterian, the use of automated border detection echocardiography allows the team to look into the heart itself to see how well it performs when the VADs are slowed or temporarily halted (Fig 2). Patients can then be placed into one of two categories: failing LV indicated by an abrupt increase in LV size and decrease in blood pressure during decreased VAD support, or recovered LV suggested by a maintained or decreased LV size during the weaning trial (Fig 3). Those that enjoy favorable initial weaning trials may then have their VADs temporarily halted (Fig 4). The simultaneous collection of additional data including arterial blood pressure then makes it possible to calculate a power value – quantifying the strength of the left ventricle, the heart’s main pumping chamber. This calculation can further distinguish those individuals that may be capable of surviving VAD explant without the need for a cardiac transplant (Fig 5).Over the last 3 years 18 patients that have had VADs implanted were studied for the possibility of ventricular recovery. Those patients that were identified as potentially recoverable individuals then underwent intensive physical therapy for further rehabilitation. Of these 18, 6 had their VADs removed and survived to hospital discharge. Two of the patients did undergo cardiac transplant, both 1 year following the removal of their VAD systems. The others are currently discharged working, attending school and performing other routine functions.
Doctors, scientists and clinicians are working aggressively at UPMC in an effort to further identify individuals who may be removed from the transplant list. (possibly a picture of the people involved) In an age where donor organs are limited, weaning a patient from the transplant list actually saves two lives – that of the person weaned off the VAD system and that of the person obtaining a transplant organ that originally would have gone to the recovered individual.