More than a third of advanced heart failure patients treated with a
combination of an artificial heart assist device, called a left
ventricular assist device, or LVAD, and intensive drug therapy have
recovered their heart function enough to allow removal of the LVAD
device, revelaed the preliminary results of an ongoing study presented
at the American Heart Association's Scientific Sessions 2016.
The multicenter trial called RESTAGE, includes 40 patients (67.5% men, average age 34.9 years) at six different centers, with very
advanced or end stage heart failure. Within the first 209 days, three
patients did not survive long enough to get the therapy and one had the
device removed. The remaining 36 patients were implanted with an LVAD
(HeartMate II) and prescribed an aggressive combination of drugs
(Lisinopril 40 mg, spironolactone 25 mg, digoxin 125 mic and losartan
150 mg daily and coreg 25 mg bid).
‘Even very advanced heart failure can be reversed using these heart pumps, particularly when combined with additional drug therapy, avoiding the need for heart transplantation for these patients.’
All of the patients were so disabled from heart failure that the
initial intent with the LVAD was to use it until they could receive a
heart transplant or to leave the device in for the rest of their lives.
"This suggests that even very advanced heart failure can be reversed
using these heart pumps, particularly when combined with additional
drug therapy, avoiding the need for heart transplantation for these
patients and making the donor heart available for another needy
individual," said Emma J. Birks, lead author of the study and
professor of medicine at the University of Louisville in Louisville,
Researchers tested the 36 patients' heart function to determine if
any had improved heart function enough from the therapy to have the
pumps removed, or if their heart function remained poor and needed a
heart transplant or to remain on the pump.
Researcher's preliminary results have found to date:
- 13 patients receiving the combination therapy had
recovered enough heart function (after an average of 344 days) to have
the pump removed.
- Two patients received transplants from the pump and one died on the pump.
- 20 patients are ongoing (two of which are also scheduled to have their devices removed).
"The fact that this could be done in several centers suggests that
using the device with this drug combination to reverse heart failure is
possible on a larger scale. It has previously been thought that these
devices rarely recover heart function enough to allow them to be
removed, but this study suggests that this can occur in a much bigger
number than originally thought, particularly if combined with drug
therapy," Birks said.