14 April 2017

A mechanical pump instead of a heart transplant

According to the results of a study conducted by researchers at the University of Newcastle, working under the guidance of Dr. Djordje Jakovljevic, almost 40% of patients with severe heart failure who were temporarily implanted with a mechanical heart pump (left ventricular auxiliary circulation apparatus), subsequently fully recovered from the disease.

Left ventricular circulatory support devices are used to temporarily support the vital functions of patients with severe heart failure waiting for a suitable donor organ for transplantation. Such patients are implanted with a battery–powered mechanical pump that helps the main contracting chamber of the heart – the left ventricle - to pump blood through the body.

Traditionally, this intervention is seen as a "therapeutic bridge" that allows the patient to survive the waiting time for a suitable transplant. However, specialists are aware of cases when such supportive therapy in combination with medication provided complete restoration of cardiac function and eliminated the need for transplantation.

58 men with heart failure participated in the clinical study conducted by the authors. 16 of them had left ventricular circulatory support devices implanted and subsequently removed due to pronounced restoration of heart functions. Another 18 had implanted heart pumps, and the remaining 24 were waiting for a donor organ transplant. On average, the duration of the device in the body was 396 days and ranged from 22 to 638 days.

The control group included 97 healthy men without heart disease. All participants were tested on a treadmill with a breathing mask that monitored oxygen utilization and pumping function of the heart.

According to the observations made, the levels of cardiac function in 38% of patients whose improvement allowed the removal of left ventricular circulatory support devices were comparable with the corresponding indicators for healthy people of the same age.

Based on this, the authors concluded that mechanical pumps can be considered not only as a temporary solution that supports the life of a patient awaiting transplantation, but also as a means potentially capable of ensuring recovery. Currently, they are already searching for markers of early recovery of cardiac function against the background of the use of a left ventricular auxiliary circulation apparatus. These markers will help attending physicians identify patients who respond well to the device and make decisions about its disconnection or explantation without the risk of recurrence of episodes of heart failure.

Heart transplantation gives a second chance to patients with severe heart failure, however, due to the acute shortage of donor organs, not all patients manage to take advantage of this chance. At the same time, the data obtained by the authors indicate that in a sufficiently large number of cases, the use of mechanical heart pumps allows patients to restore cardiac function without resorting to transplantation, associated with a high risk of complications and a lifelong need to take immunosuppressive drugs that prevent the development of a rejection reaction of the donor organ.

Article by Djordje G. Jakovljevic et al. Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure is published in the Journal of American College of Cardiology.

Evgeniya Ryabtseva                                                                                                 
Portal "Eternal youth" http://vechnayamolodost.ru based on materials from Newcastle University – From heart failure to health: Pump shown to restore organ to fitness.


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