Clinical characteristics and long‐term outcomes in patients with peripartum cardiomyopathy (PPCM) receiving left ventricular assist devices (LVAD)

Background Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF), presenting with left ventricular (LV) systolic dysfunction either at the end of pregnancy or in the months following delivery. In rare cases, PPCM leads to severe impairment of LV function, refractory cardiogenic shoc...

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Published in:Artificial organs 2023-02, Vol.47 (2), p.417-424
Main Authors: Berliner, Dominik, Li, Tong, Mariani, Silvia, Hamdan, Righab, Hanke, Jasmin, König, Tobias, Pfeffer, Tobias Jonathan, Abou‐Moulig, Valeska, Dogan, Günes, Hilfiker‐Kleiner, Denise, Haverich, Axel, Bauersachs, Johann, Schmitto, Jan D.
Format: Article
Language:English
Subjects:
Adult
bridge to recovery
bridge to transplant
Cardiomyopathies - complications
Cardiomyopathies - surgery
Cardiomyopathy
Congestive heart failure
destination therapy
Female
Heart Failure - complications
Heart Failure - surgery
Heart-Assist Devices - adverse effects
Hemodynamics
Humans
Implantation
LVAD
Patients
Peripartum Period
PPCM
Pregnancy
Recovery
Retrospective Studies
Shock, Cardiogenic - therapy
Transplantation
Treatment Outcome
Ventricle
Ventricular assist devices
Ventricular Dysfunction, Left - complications
Ventricular Dysfunction, Left - therapy
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Summary:Background Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF), presenting with left ventricular (LV) systolic dysfunction either at the end of pregnancy or in the months following delivery. In rare cases, PPCM leads to severe impairment of LV function, refractory cardiogenic shock or advanced HF. LV assist devices (LVAD) have been shown to be a feasible treatment option in advanced HF. However, little is known about long‐term outcomes and prognosis of PPCM patients undergoing LVAD implantation. Methods A retrospective analysis of data from PPCM patients undergoing LVAD implantation in two tertiary centers with respect to long‐term outcomes was performed. Results Twelve patients of median age 30 (18–39) years were included. Eight patients were experiencing cardiogenic shock (INTERMACS 1) at implantation. Seven patients were implanted within 1 month of their PPCM diagnosis. Median duration of LVAD support was 19 (2–92) months with median follow up of 67 (18–136) months (100% complete). In‐hospital and 1‐year mortality were 0% and 8.3%, respectively. Two patients died on LVAD support, four patients were successfully bridged to transplantation, two patients are still on LVAD, and four were successfully weaned due to sufficient LV recovery (one died after LV function deteriorated again). Conclusion LVAD treatment of decompensated end‐stage PPCM is feasible. Early LVAD provision led to hemodynamic stabilization in our cohort and facilitated safe LV recovery in one third of these young female patients. Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) appearing towards the end of pregnancy or in the months following delivery and seldom leads to refractory cardiogenic shock or advanced HF. We retrospectively analyzed data on PPCM patients undergoing LV assist devices (LVAD) implantation in two tertiary centers. Implantation of LVAD is feasible in PPCM patients – provision of mechanical support led to stabilization of the cardiac situation and facilitated recovery of LV function in one third of these young female patients.
ISSN:0160-564X
1525-1594
DOI:10.1111/aor.14406