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. 2019 Oct;33(10):e13663.
doi: 10.1111/ctr.13663. Epub 2019 Jul 29.

Mechanical circulatory support for cardiac amyloidosis

Michelle M Kittleson  1 , Robert M Cole  1 , Jignesh Patel  1 , Danny Ramzy  1 , Elizabeth Passano  1 , David H Chang  1 , Dael R Geft  1 , Lawrence Czer  1 , Robert Vescio  1 , Joshua Chung  1 , Jon A Kobashigawa  1 , Francisco Arabia  2 , Fardad Esmailian  1 , Jaime D Moriguchi  1
Affiliations

Mechanical circulatory support for cardiac amyloidosis

Michelle M Kittleson et al. Clin Transplant. 2019 Oct.

Abstract

Background: Cardiac amyloidosis, typically from abnormal deposition of AL or ATTR amyloid protein, can result in heart failure requiring transplantation (HTx). The role of mechanical circulatory support (MCS) is not well-established. The purpose of this study was to present our experience with MCS in patients with cardiac amyloidosis.

Methods: Consecutive patients with cardiac amyloidosis who received MCS at Cedars-Sinai Medical Center between 2010 and 2018 were reviewed. Clinical characteristics and outcomes were compared to a control group of MCS patients without amyloid matched 2:1 for age and INTERMACS Profile.

Results: 11 amyloid patients underwent durable MCS, two with paracorporeal biventricular assist devices and 9 with total artificial hearts. No patients received isolated left ventricular assist device support. By 1 year, 9 (82%) of patients in the MCS-Amyloid group had been transplanted and 2 (18%) had died. In the MCS-No Amyloid group, by 1 year, 8 (36%) of patients had been transplanted, 10 (46%) had died, and 4 (18%) were still living with MCS.

Conclusions: Over a 9-year period, patients with amyloid cardiomyopathy who required MCS at our institution all received durable biventricular MCS. For carefully selected patients, this approach is feasible with acceptable outcomes as bridge to transplantation.

Keywords: cardiac amyloidosis; mechanical circulatory support; total artificial heart.

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References

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