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For the first time ever LVAD's eliminated the need for a heart transplant.

For the first time left ventricular assist devices (LVADs) have eliminated the need for a transplant by restoring failing hearts of some heart failure patients, according to a report in the annual Cardiovascular Surgery Supplement of Circulation: Journal of the American Heart Association.

"For selected patients, this approach offers a clinical option with potentially successful cardiac stability lasting more than five years after weaning from the LVAD. Even 10 years does not appear to be the upper limit," said Michael Dandel, MD, first author of the report and senior physician and cardiologist at the Deutsches Herzzentrum Berlin in Germany.

Dandel cautioned that it is too soon for the experimental procedure to become a standard treatment, however.

"Even the idea of stable improvement in chronic end-stage heart failure leading to more or less complete cardiac recovery of cardiac function is a matter of controversy," Dandel pointed out.

The report assesses the outcomes of 30 men and two women who had LVADs removed between March 1995 and March 2004. All the patients initially were put on pumps to prepare for a heart transplant. The researchers reported finding no pre-implant physical signs or blood readings that predicted cardiac recovery during mechanical support. Instead, they concluded that physicians must rely on the results of ultrasound readings of the heart taken after an LVAD is implanted to determine the likelihood of cardiac stability after the pump is removed.

The researchers listed three primary criteria for deciding whether to remove the LVAD without a subsequent heart transplant:

*The heart's size and function must remain satisfactory during short periods when the pump is turned off.

*The person's heart failure should have lasted no more than five years.

*The patient must have normal heart rhythm, an absence of severe pulmonary hypertension, and no evidence of severe heart valve problems.

The major barriers to using LVADs widely to restore heart strength include the lack of reliable criteria to predict cardiac recovery, the potential complications of inserting an LVAD, and the relatively low probability that recovery will occur, the report said.

Dandel concluded that "our good results may in the future encourage physicians and patients to choose the option of LVAD removal, instead of heart transplantation, if there is evidence of sufficient cardiac improvement."
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Title Annotation:left ventricular assist devices
Publication:Transplant News
Geographic Code:1USA
Date:Sep 30, 2005
Words:374
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