Left ventricular assist system as a bridge to myocardial recovery

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Left ventricular assist system as a bridge to myocardial recovery O.H Frazier, MD, Timothy J Myers, BS The Annals of Thoracic Surgery Volume 68, Issue 2, Pages 734-741 (August 1999) DOI: 10.1016/S0003-4975(99)00801-2

Fig 1 Hemodynamic changes: before implantation of left ventricular assist system (LVAS) (pre-LVAS), during LVAS support (LVAS), and after LVAS removal (post-LVAS). Pulmonary capillary wedge pressure, left ventricular ejection fraction, and cardiac index improved significantly during support, and these improvements were sustained after LVAS removal. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 2 (Patient 1.) Chest roentgenograms (A) during left ventricular assist system (LVAS) support and (B) 6 months after LVAS removal. Cardiomegaly seen early during LVAS support normalized before removal of the device and remained normal at the 6-month follow-up. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 3 (Patient 2.) Results of stress dobutamine study performed after 5 months of vented electric left ventricular assist system support. The rate of rise of left ventricular pressure (dP/dT) and the cardiac index rose to normal levels with increasing doses of dobutamine. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 4 (Patient 3.) Results of stress dobutamine study performed after 6 months of vented electric left ventricular assist system support. The rate of rise of left ventricular pressure (dP/dT) and the cardiac index increased to normal levels at a dose of 20 μg · kg−1 · min−1. Cardiac index, however, decreased at 30 and 40 μg · kg−1 · min−1. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 5 (Patient 3.) Representative histologic findings at time of implantation of left ventricular assist system (LVAS) and at LVAS removal 14 months later. The myocyte diameter decreased from 41.6 μm to 30.6 μm. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 6 (Patient 4.) Results of stress dobutamine study performed after 5.5 months of support with implantable pneumatic left ventricular assist system. The rate of rise of left ventricular pressure (dP/dT) and the cardiac index rose to normal levels with increasing doses of dobutamine. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 7 (Patient 5.) Serial echocardiograms demonstrated marked improvements in left ventricular dimensions and function during left ventricular assist system support. These improvements were sustained after device removal. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)

Fig 8 (Patient 5.) Results of stress dobutamine study performed after 40 days of left-sided support with a Thoratec ventricular assist system. Left ventricular dimensions and function improved to normal levels with increasing doses of dobutamine. The Annals of Thoracic Surgery 1999 68, 734-741DOI: (10.1016/S0003-4975(99)00801-2)