Left Ventricular Assist Device as Bridge to Recovery - Single Center Experience of Successful Device Explantation

2020 
Purpose Continuous flow left ventricular assist devices (CF-LVAD) have been shown to enhance reverse remodeling and myocardial recovery in certain patients. We sought to analyze the characteristics of patients who underwent CF-LVAD explantation at a large academic institution. Methods In this study we retrospectively identified all patients who underwent CF-LVAD explants due to recovery from 2006 to 2019 at a single large academic institution. Patient baseline characteristics and data on pre and post-explant evaluation were collected and analyzed. Results Of 421 patients that underwent CF-LVAD implantation, 13 underwent explantation (3.1%). Twelve HeartMate II and one HeartWare LVAD were explanted. Seven patients were male (53.9%) with a mean age of 45.4± 5 years. The etiology of cardiomyopathy was nonischemic in 100% of the patients (4 had peripartum cardiomyopathy). Median time from heart failure (HF) diagnosis to LVAD implant was 12 months (IQR, 2-44 months). Eight patients failed guideline-directed medical therapy and 5 patients presented with acute HF. Median time supported on LVAD was 22 months (IQR, 11-28 months). Mean follow-up time post-explant was 37 ±10.7 months. Two patients died within 30 days from explant due to right HF, one related to severe pulmonary hypertension and the other severe COPD. Three additional patients died during the follow-up period (mean follow up time post-explant of 43.6 months) and all were noted to be non-adherent to medical therapy. Ejection fraction (EF) improved from 12.3 ±3.9% pre-implant to 48.8 ±12.4% pre-explantation (p Conclusion We present a large single center experience of successful CF-LVAD explantation in the setting of myocardial recovery. Of those who died, early death was related to acute right heart failure however, in the long term, medical noncompliance may have been related to heart failure recrudescence. Future studies are needed to determine if recovery strategy can be applied to more patients with end stage heart failure.
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