Left Ventricular Assist Device (LVAD) Explant versus Decommissioning for LV Recovery

Purpose Left ventricular assist device (LVAD) explant or decommission for LV recovery is rare (1-2%). Furthermore, details regarding appropriate patient selection, surgical technique and short- and long-term patient outcomes are limited (1,2). Four different surgical techniques have been described for cessation of LVAD support for LV recovery (3). The purpose of our study is to describe our experience for patients undergoing LVAD explantation or decommission. Methods We retrospectively reviewed the surgical technique and outcomes for our LVAD patients who were explanted and decommissioned between 2010 and 2020. Baseline demographics were examined. Specific surgical techniques utilized along with outcome analysis including infection, thromboembolic events, LVEF change, need for re-implantation and death were analyzed. Results Thirteen patients were identified who underwent either LVAD explant or decommission with a mean age of 43. All patients had underlying non-ischemic cardiomyopathy. Nearly half (53%) of the patients were selected due to a combination of LV recovery (mean LVEF 47% in this group) and an indication for device removal including pump thrombosis or infection (versus LV recovery alone). Surgical technique varied between full sternotomy with pump explant (69%) and thoracotomy with pump decommission (31%) depending on indication. Median follow up was 70 months. Results are displayed in table 1. In those with LV recovery alone, many experienced a drop in LVEF with clinical HF symptoms, but not resulting in re-implantation or mortality. All patients with infection and LV recovery experienced a drop in LVEF and recurrent HF, with a mortality rate of 50%. Conclusion LVAD explant or decomissioning can be performed via full sternotomy or thoracotomy depending on the indication. When performed for LV recovery and another reason, such as device infection, recurrent, severe HF can be fatal in this cohort. Careful monitoring of these patients is therefore required after such an operation.