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Mechanical Circulatory Support in Special Populations

Explore the unique characteristics and outcomes of women with PPCMP who received MCS, comparing results with other groups. Highlights survival rates, implant strategies, and post-transplant outcomes.

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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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