Treatment of peripartum cardiomyopathy with mechanical assist devices and cardiac transplantation.

Background: Peripartum cardiomyopathy is a life threatening illness. If maximal medical therapy fails, patients may then be treated with mechanical circulatory support devices and (or) cardiac transplantation. Our purpose is to demonstrate the long-term efficacy of these surgical interventions.

Methods: A retrospective review of 18 patients diagnosed with peripartum cardiomyopathy from 1994 to 2009 was conducted.

Results: Eighteen patients were referred with a median of seven year delay between onset of symptoms and presentation. Eight (44%) had medical therapy with only one death at five years, seven are alive, and two patients are awaiting transplantation. Six patients were implanted with devices. From this group, there were two hospital deaths, one native heart recovery, and three heart transplants with 100% survival. Four patients (21%) were treated with transplantation alone and all survived. Combined device and (or) transplant survival was 80% at one year.

Conclusions: The natural history of this group varied; 38% of the medically treated patients are stable on medical therapy (3 of 8) and 67% of the device patients (4 of 6) are alive. One of six device patients (17%) was successfully bridged to native heart recovery. Mechanical assist devices can be used as a bridge to recovery or as a bridge to cardiac transplantation for the treatment of peripartum cardiomyopathy patients who fail medical management. In addition, cardiac transplantation alone is also a viable treatment option for patients who fail medical management and do not require a mechanical assist device.