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New Therapies may Help to Avoid Transplant in Some Heart Failure Patients

tage heart failure between August 2001 and October 2003 in the first prospective, multicenter study to extensively examine how LVADs affect cardiac function and exercise capacity over several months.

Patients were recruited from these centers: Baylor College of Medicine, Houston, Texas; Cleveland Clinic Foundation, Ohio; Columbia University, New York City; University of Michigan, Ann Arbor; University of Minnesota, Minneapolis; Temple University, Philadelphia, Penn.; and the Texas Heart Institute, Houston. Four different types of LVADs were used in the study. Researchers evaluated the patients every 30 days after pump implant.

"There are two contrasting, important findings in our study," Maybaum said. "One, the ability to remove an LVAD from a patient with end-stage heart failure was low. Two, there was a high degree of improvement in heart function during the use of the assist device."

Six (9 percent) of the 67 patients had their pump removed without needing a heart transplant. Six others (9 percent) had died by May 2004, when data collection ended.

Yet, after 30 days on the pump, one third of the patients had a left ventricular ejection fraction greater than 40 percent (measured when the pump flow was decreased). Ejection fraction is the percentage of blood pumped out of the left ventricle with each beat. Healthy hearts typically have an ejection fraction of 55 percent to 60 percent, Maybaum said. The proportion of patients showing this degree of improvement then waned, dropping to 27 percent of patients at 60 days, 19 percent at 90 days and 6 percent at 120 days.

Patients also showed progressive improvement in exercise capacity after LVAD implantation. From day 30 to 120 there was an increase in their peak oxygen consumption and how long they could exercise.

Tiny snips of heart tissue from 22 patients taken at implant and at the time of removal of the LVAD prior to transplan
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