Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Data from the Interagency Registry for Mechanically Assisted Circulatory Support

Abstract

Background: We describe the characteristics and outcomes of peripartum cardiomyopathy (PPCMP) patients who received durable mechanical circulatory support and compared it with other etiologies of advanced heart failure.

Methods and results: We analyzed 1258 women who were registered in Interagency Registry for Mechanically Assisted Circulatory Support between June 2006 and March 2012. Baseline characteristics, implant strategies, hemodynamics, echocardiographic data, and outcomes were compared. Ninety-nine women had PPCMP and 1159 had non-PPCMP as primary diagnosis. PPCMP women were younger (P<0.001), more likely to be blacks, and had less comorbidities than non-PPCMP patients. PPCMP women had better survival than non-PPCMP women (P=0.01) with a 2-year survival of 83%. Multivariable risk factor adjustment analysis showed that the improved survival was likely because of younger age and fewer comorbidities. At 36 months, a proportion of 48% PPCMP received heart transplantation. Recovery occurred at a frequency of 6% and 2% in the PPCMP and non-PPCMP groups (P=0.1). Adverse event rates were similar in PPCMP and non-PPCMP patients except for higher cardiac arrhythmias and respiratory failure in the non-PPCMP in the first 3 months post implant.

Conclusions: PPCMP women who receive durable mechanical circulatory support have a better survival than women with non-PPCPM. The improved survival observed in PPCMP is likely related to their fewer comorbidities and younger age. Myocardial recovery was uncommon and less than half of women with end-stage PPCPM received heart transplantation after 3 years of mechanical support.

Keywords: cardiomyopathies; heart-assist devices; postpartum period.