Author + information
- Received December 7, 2016
- Revision received February 4, 2017
- Accepted February 6, 2017
- Published online April 10, 2017.
- Djordje G. Jakovljevic, PhDa,∗ (, )
- Magdi H. Yacoub, MD, PhDb,
- Stephan Schueler, MD, PhDc,
- Guy A. MacGowan, MDc,
- Lazar Velicki, MD, PhDd,
- Petar M. Seferovic, MD, PhDe,
- Sandeep Hothi, PhDf,
- Bing-Hsiean Tzeng, MD, PhDg,
- David A. Brodie, DScih,
- Emma Birks, MD, PhDi and
- Lip-Bun Tan, DPhilj
- aInstitute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Clinical Research Facility, Newcastle Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- bImperial College London, London, United Kingdom
- cCardiothoracic Centre, Freeman Hospital, and Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, United Kingdom
- dFaculty of Medicine, University of Novi Sad, and Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Novi Sad, Serbia
- eCardiology Department, Clinical Centre Serbia, Medical School, Belgrade, Serbia
- fPhysiological Laboratory and Murray Edwards College, University of Cambridge, Cambridge, and Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom
- gDivision of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital and Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- hCardiovascular Research Centre, Buckinghamshire New University, Bucks, London, United Kingdom
- iDepartment of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
- jLeeds General Infirmary, Cardiology and Institute of Medical Sciences, Leeds University, Leeds, United Kingdom
- ↵∗Address for correspondence:
Dr. Djordje G. Jakovljevic, Medical School, Newcastle University, Institute of Cellular Medicine and Newcastle Cardiovascular Research Centre, William Leech Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom.
Background Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery.
Objectives This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls.
Methods Fifty-eight male patients—18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)—and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O2 consumption.
Results All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O2 consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls.
Conclusions The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.
Dr. Jakovljevic is currently supported by Research Councils’ UK Centre for Ageing and Vitality at Newcastle University. Dr. Yacoub has received institutional research funding from St. Jude Thoratec. Dr. Schueler has received research funding from HeartWare; and has served as an advisor and proctor for HeartWare. Dr. MacGowan has research funding from HeartWare. Dr. Birks has received institutional research funding from St. Jude Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 7, 2016.
- Revision received February 4, 2017.
- Accepted February 6, 2017.
- 2017 The Authors