Introduction: Patients with Restrictive Cardiomyopathy (RCM) have a high mortality rate on the heart transplant waiting list due to being less suitable for mechanical support devices and/or drug therapy. We analyzed the basic characteristics, surgical technique, and early outcomes of two patients who used Left Ventricular Assist Device (LVAD) as a bridge to heart transplantation.
Materials and Methods: The waiting time for heart transplantation for our patients was 7 years and 6 years, respectively. In the first patient, the left ventricular end-diastolic diameter (LVEDD) was 49mm and EF was 21%. The support device was placed at the apex of the left ventricle by excising the mitral valve. LVAD follow-up was performed by evaluating the atrial septum and IVC diameter with echocardiography. Heart transplantation was performed on the 118th postoperative day after a suitable heart became available.
Results: Due to the long waiting time for the second patient, the PVR value increased from 3.67WU to 11.36WU. The decision was made to remove the patient from the transplant list and perform LVAD. LVEDD was 48mm and EF was 47%. The mitral valve was excised, and mitral valve replacement was performed with a bi-leaflet mechanical heart valve. The support device was placed at the apex of the left ventricle. The patient under follow-up is expected to meet the criteria for heart transplantation.
Conclusion: Patients with RCM have a poor prognosis. The only way to improve their life expectancy and quality of life is through heart transplantation. However, long waiting times on the transplant list, the development of pulmonary hypertension in most patients, and the limitation of LVAD use due to the small size of the left ventricle increase mortality in this group. Surgical differences should be considered to increase the use of LVAD in these patient groups.