Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population
Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importanc...
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| Format: | Article |
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MDPI AG
2022-10-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/11/1681 |
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| author | Anca Racolta Jae-Hyun Johannes Ahn Marinos Kantzis Hendrik Milting Volker Lauenroth Hermann Körperich Eugen Sandica Stephan Schubert Kai Thorsten Laser |
| author_facet | Anca Racolta Jae-Hyun Johannes Ahn Marinos Kantzis Hendrik Milting Volker Lauenroth Hermann Körperich Eugen Sandica Stephan Schubert Kai Thorsten Laser |
| author_sort | Anca Racolta |
| collection | DOAJ |
| description | Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD). Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. They were monitored regularly using clinical information and functional imaging with VAD support. Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Finally, pump stops of up to 30 min were performed once a week (phase C). The final decision on explantation was based on at least three pump stops. Two patients were weaned and successfully removed from the VAD. One of them was diagnosed with acute viral myocarditis. The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. The noninvasive assessment of cardiac output and strain under different loading conditions during VAD therapy is feasible and helps identify candidates for weaning despite severe histological findings. The presented protocol, which incorporates new echocardiographic techniques for determining volume and deformation, can be of great help in positively guiding the process of individual recovery, which may be essential for selecting and increasing the number of patients to be weaned from VAD. |
| first_indexed | 2024-03-09T18:55:36Z |
| format | Article |
| id | doaj.art-47b1b88d459f442da3f19be909d95039 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T18:55:36Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-47b1b88d459f442da3f19be909d950392023-11-24T05:29:12ZengMDPI AGLife2075-17292022-10-011211168110.3390/life12111681Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric PopulationAnca Racolta0Jae-Hyun Johannes Ahn1Marinos Kantzis2Hendrik Milting3Volker Lauenroth4Hermann Körperich5Eugen Sandica6Stephan Schubert7Kai Thorsten Laser8Clinic for Pediatric Cardiology, Center for Congenital Heart Defects, University Hospital RWTH Aachen, 52074 Aachen, GermanyPediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyUniversity Hospital Leicester, NHS Trust EMCHC, Leicester LE1 5WW, UKErich and Hanna Klessmann Institute, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyClinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyInstitute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyPediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyPediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyPediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, GermanyPatients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD). Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. They were monitored regularly using clinical information and functional imaging with VAD support. Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Finally, pump stops of up to 30 min were performed once a week (phase C). The final decision on explantation was based on at least three pump stops. Two patients were weaned and successfully removed from the VAD. One of them was diagnosed with acute viral myocarditis. The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. The noninvasive assessment of cardiac output and strain under different loading conditions during VAD therapy is feasible and helps identify candidates for weaning despite severe histological findings. The presented protocol, which incorporates new echocardiographic techniques for determining volume and deformation, can be of great help in positively guiding the process of individual recovery, which may be essential for selecting and increasing the number of patients to be weaned from VAD.https://www.mdpi.com/2075-1729/12/11/1681congestive heart failuredilatative cardiomyopathyassist deviceBerlin Heartweaningmyocarditis |
| spellingShingle | Anca Racolta Jae-Hyun Johannes Ahn Marinos Kantzis Hendrik Milting Volker Lauenroth Hermann Körperich Eugen Sandica Stephan Schubert Kai Thorsten Laser Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population Life congestive heart failure dilatative cardiomyopathy assist device Berlin Heart weaning myocarditis |
| title | Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population |
| title_full | Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population |
| title_fullStr | Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population |
| title_full_unstemmed | Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population |
| title_short | Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population |
| title_sort | cardiac muscle training a new way of recognizing and supporting recovery for lvad patients in the pediatric population |
| topic | congestive heart failure dilatative cardiomyopathy assist device Berlin Heart weaning myocarditis |
| url | https://www.mdpi.com/2075-1729/12/11/1681 |
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