A new study finds that although few patients recover after receiving a left ventricular-assist device (LVAD), a new risk score may be able to foresee how likely these patients are to recuperate.
A team of researchers evaluated the incidence of cardiac recovery with an a priori LVAD implantation strategy of bridge-to-recovery (BTR) and constructed I-CARS, a score designed to predict recovery in study participants, which included LVAD recipients registered in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Cardiac recovery was evaluated in BTR and non-BTR patients.Among the 15,138 INTERMACS patients, cardiac recovery occurred in 192, or 1.3%. The incidence of recovery was 11.2% in BTR, compared with 1.2% in non-BTR patients. Independent predictors of recovery included age, nonischemic cardiomyopathy, time from cardiac diagnosis, absence of ICD, creatinine level, and left ventricular end-diastolic diameter. The weighted I-CARS score effectively stratified patients based on their probability of recovery. One-year survival after LVAD removal, available in INTERMACS for 21 patients, was 86%.
“LVAD technology has improved significantly over the past decade, and an increasing number of patients live with LVADs for extended periods of time,” said Josef Stehlik, MD, MPH, an associate professor of medicine at the University of Utah School of Medicine, and co-author of the study.
“As such, primary care physicians are more and more likely to care for patients who also have LVADs,” he said, noting that an LVAD is used for many patients until they can get a transplant or as permanent therapy for those not waiting for transplant.
“We are learning more about the potential of the heart to heal during LVAD support,” Dr Stehlik said. “Our study provides new information regarding patient characteristics that can predict which hearts are most likely to improve on LVAD support. This will hopefully allow for higher number of patients to have their LVADs removed after this healing (myocardial recovery) takes place.”
Wever-Pinzon O, Drakos SG, McKellar SH, et al. Cardiac recovery during long-term left ventricular assist device support. J Am Coll Cardiol. 2016;68(14):1540-1553.