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Mechanical Circulatory Support in Special Populations

Mechanical Circulatory Support in Special Populations. “ Peripartum Cardiomyopathy”. Renzo Y. Loyaga-Rendon MD.,PhD .. Assistant Professor Advanced Heart Failure Section University of Alabama at Birmingham. PPCMP as Special Population. - Women.

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Mechanical Circulatory Support in Special Populations

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  1. Mechanical Circulatory Support in Special Populations “Peripartum Cardiomyopathy” Renzo Y. Loyaga-RendonMD.,PhD.. Assistant Professor Advanced Heart Failure Section University of Alabama at Birmingham

  2. PPCMP as Special Population - Women : Mean age 23-33. Approximately 60% are older than 30 years. - Age - Race : It has been described in Caucasians, African Americans, Hispanics and Asians. However, the incidence in African Americans is considerably higher.

  3. PPCMP as Special Population : - 2.5 - 5 cases per each 10 000 live births. - 1 case for every 3186 women delivering a baby. - 1350 women in the US are affected each year. - Incidence • Clinical course : Recovery of LV function on medical therapy. - At 6 months 60% improve EF and 45% normalize EF. - Transplant rates 5-11%. - 5% of Transplant recipients have PPCMP.

  4. PPCMP as Special Population Post-transplant outcomes •  Rejection • Sensitization • Allograft failure • Retransplantation Rasmusson et al, JHLT 2012;31:180-6

  5. PPCMP as Special Population Unknown pathophysiology

  6. PPCMP, clinical course. 5 m 1 m 48-62% >55 Symptom onset Explant 45 LVEF (%) 35 37-45% LVAD/HTx 25 MCS LVAD HTx 6-25% 15 Time Delivery

  7. Objectives • To describe the baseline characteristics of patients with PPCMP who received MCS. • To compare the outcomes of PPCMP patients who received MCS with Non-PPCMP. Circ Heart Failure 2014;7:300-309

  8. Study Population INTERMACS Women >14 yo June 23, 2006 and March 31, 2012 1258 ICMP 388 NICMP 771 PPCMP 99 Non-PPCMP 1159

  9. Patient characteristics

  10. Type of Durable Mechanical Circulatory Support

  11. Implantation Strategy

  12. Severity of Disease at Implantation(INTERMACS profile)

  13. Unadjusted Survival 85% 83% 68% 76% 64% 52% p = 0.01

  14. Unadjusted Survival PPCMP vs. ICMP vs NICMP

  15. Unadjusted Survival in PPCMP Pulsatile vs. Continuous flow LAVD 88% 85% 78%

  16. Competing Outcomes in PPCMP 48 % 25.5 % 20 % 6 %

  17. Why do PPCMP patients have an improved survival?

  18. Characteristics of PPCMP patients according to Heart Failure DurationPPCMP (n=99)

  19. Type of Device implanted in PPCMP patients according to Heart Failure DurationPPCMP (n=99)

  20. Implantation strategy in PPCMP patients according to Heart Failure DurationPPCMP (n=99)

  21. Severity of Heart Failure (INTERMACS PROFILE) in PPCMP patients according to Heart Failure DurationPPCMP (n=99)

  22. Outcomes at 36 months in PPCMP patients according to Heart Failure DurationPPCMP (n=99)

  23. Updated survival data 56% 47%

  24. Comparison of survival in PPCMP women receiving Advanced Heart Failure Therapies

  25. Heart Transplant Vs. LVAD 79% 67% Survival (%) 57% 47% 3 4 1 2 Years

  26. Heart Transplant Vs. LVAD 84% 81% 78% 75% 79% 67% Survival (%) 57% 47% 3 4 1 2 Years

  27. Heart Transplant Vs. LVAD 84% 81% 78% 83% 75% 73% 68% 79% 62% 67% Survival (%) 57% 47% 3 4 1 2 Years

  28. Heart Transplant Vs. LVAD 87% 84% 81% 81% 78% 83% 75% 73% 70% 79% 62% 68% 67% Survival (%) 57% 57% 47% 3 4 1 2 Years

  29. Conclusions • Women with PPCMP represent an special population, who have improved survival after MCS. • Heart transplantation is achieved in < 50% of PPCMP patients who received MCS. • Explant due to recovery is rare in PPCMP.

  30. Thank you

  31. Conclusions • Despite of over 20% of peripartum cardiomyopathy patients presenting in cardiogenic shock at the time of implantation, the 2 year survival of this cohort was greater than 80% at 2 years.! • This improved survival is likely explained by the fewer comorbidities and younger age observed in PPCMP women.

  32. Conclusions • Unfortunately at 3 years, Heart Transplantation was achieved in less than 50% of peripartum cardiomyopathy women receiving MCS. • Despite the seemingly favorable environment for recovery (acute onset, younger age, Non-ischemic etiology) the recovery was disappointingly uncommon (6%).

  33. Duration of Heart Failure prior to Device Implantation

  34. Predicted Survival in the PPPCMP and Non-PPCMP patients based on the prevalence of risk factors in the specific group 100 PPCMP 75 Survival (%) Non - PPCMP 50 25 P < 0.05 18 24 36 12 6 30 Time post implant (months)

  35. Predicted Survival in the PPCMP and Non-PPCMP patients based on the overall prevalence of risk factors 100 PPCMP 75 Survival (%) Non - PPCMP 50 25 p = 0.07 0 18 24 36 12 6 30 Time post implant (months)

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