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Forum Name: Heart Failure

Question: transplant or LVAS ?


 alana820 - Sun Apr 06, 2008 11:06 am

I am a 20 year old male dx mid 2006 with idiopathic dilated cardiomyopathy and ejection fraction then of 25% , over the following year meds raised the EF to 35% and had no symptoms. In September of 2007 I started to get out of breath very easily and began coughing had my checkup with another echo and EF was down to 18% it was then discused about a transplant. I am now in the process of being evaluated for one but have come across some articles about left ventricular assist system which has been approved in Europe and Canada for long term use in heart failure instead of just a bridge to transplant. Just last week there was something about a Texas woman recovering completely after having the pump in for a year. What are your views on this ? The hospital I will be having the transplant in is doing a study /clinical trial on the use of the LVAS I don't know if I would meet all the criteria for it but when I asked my cardiologist he just said that it would be better to go with something we already know works. I also had a defibrillator put in 1 month ago, sorry I am asking so many questions but the thought of the transplant and the follow up after really scares me and I would like them to think about another way to do this thanks in advance for your time
 Dr. A. Madia - Thu Apr 10, 2008 6:02 am

User avatar Hi,

Dilated cardiomyopathy with severe left ventricular dysfunction is difficult to treat. Even after optimal antifailure treatment with ACE inhibitors, Beta Blockers, diuretics and digitalis there remains a large body of patient with effort intolerance and decreased qaulity of life not to mention increased mortality.

Novel pharmacologic therapies therapies have evolved consisting of L arginine, Co Enzyme q 10, sildenafil citrate, etc. However hard evidnce is lacking on effectiveness of these therapies.

Next comes your heart transplant and LV assist device. LVAS was till now considered a bridge therapy in patints on transplant list. However recent evidence is encouraging as to its benefit for medium term as a stand alone therapy.

One more option is Cardiac Resynchrinization Therapy, also known as bi-ventricular pacing. Its effectiveness has been shown in cases of heart failure who meet the criteria like EF less than 25 %, NYHA class III plus symptoms, EKG showing left bundle branch block with QRS duration more than 0.12 secs.

Its best to discuss out all these options with your cardiologist before reaching a decision. I have attached some references for your perusal.

Apurva.

References:

1. http://content.nejm.org/cgi/content/short/345/20/1435
2. http://jtcs.ctsnetjournals.org/cgi/cont ... 122/6/1186
3. http://www.ahrq.gov/clinic/tp/resyntp.htm

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