(216) Combined Strategy to Induce Myocardial Recovery in Children with Advanced Heart Failure: Single Center Retrospective Study

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S106 - S107
• Main Authors: Adorisio, R., Cantarutti, N., Bellettini, E., Ingrasciotta, G., Mencarelli, E., Grandinetti, M., Kirk, R., Amodeo, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.1520

Left ventricular assist device (LVAD) allowed improved survival in the pediatric population and bridged successfully to heart transplant. The beneficial effect of LVAD encompasses LV unloading, leading to inverse remodelling. In some cases, recovery can result in significant improvement in cardiac function allowing LVAD removal. Some studies suggested medical therapy might play a role in promoting cardiac recovery combined with LVAD. Few data are currently available in children about a combined medical and LVAD strategy to induce myocardial recovery. To verify the hypothesis that a strategy including optimized LVAD unloading combined with maximized anti heart failure treatment (MaHFT) was effective to induce myocardial recovery. The primary outcome was LVAD explantation.
This is a single center retrospective analysis of all patients with dilated cardiomyopathy or myocarditis receiving durable LVAD support from 2017 to 2022 at Bambino Gesù Children's Hospital in Rome. Patients’ clinical data and outcomes were recorded. The MaHFT included: β blockers (carvedilol- 1 mg/kg/d or bisoprolol- 0.4 mg/kg/d), ACE inhibitors (enalapril 0.4 mg/kg/d) and a MRA (3 mg/kg/d). Ivabradine was added in those in which the heart rate was not reduced below the 20% from the baseline. Accordingly to the strategy all patients were divided in two groups: LVAD alone (group 1) or LVAD+MaHFT (group 2). A chi squared analysis was conducted in order to evaluate the beneficial effect of this strategy in terms of weaning of LVAD.
23 patients (14 M; age: 7,4 ± 7,2 years) underwent durable LVAD implantation from 2017 to 2022. At the time of implant, all patients were in PEDIMACS2. Pulsatile LVAD used in 17, and continuous LVAD in 6. 10 received MaHFT. In group 1, only one (1/13) reached the criteria for explantation while in the group 2, 8/10 reached the criteria for explantation and were weaned from LVAD (p = 0.002). After explantation survival free from LVAD or transplantation was 90% at 1-year and 77% at 3 years.
Whilst the numbers are small, these results demonstrate that a combined strategy of LVAD and MaHFT can lead to a significant increase in myocardial recovery permitting LVAD explanation with sustained myocardial recovery in at least the short to medium term.