Outflow Cannula Systolic Slope as a Predictor of Myocardial Recovery Leading to Successful LVAD Decommission: A Case Series

PURPOSE In patients implanted with durable left ventricular assist device (LVAD), the incidence of myocardial recovery leading to device explant or decommission is low, and reliable predictors of myocardial recovery remain lacking. Here, we investigate the potential of outflow cannula systolic slope as a non-invasive predictor of successful LVAD liberation amongst select cohort of patients with high recovery potential. METHODS We first identified a cohort of patients with high recovery likelihood by querying all LVAD patients at our institution who underwent reverse ramp test, a protocol developed to assess native myocardial contractility with sequential LVAD turn-down to minimal support. We then queried all echocardiographic studies of these patients within one year of the reverse ramp tests. In the subset of patients with adequate Doppler images of the outflow cannula, the systolic slope, a load-independent marker of contractility, was measured as previously described, and the clinical outcomes were correlated. RESULTS Between September 1, 2015 and August 23, 2019, a total of 10 patients underwent reverse ramp test at our institution per published protocol. Of these, 4 patients had adequate echocardiographic window of the LVAD outflow cannula, and the systolic slope was calculated. 3 of the 4 patients had outflow cannula systolic slope of 1200 cm/s2 (1788 cm/s2), and she underwent successful percutaneous decommission of her LVAD device (bottom figure). CONCLUSION In a small case series of 4 patients from reverse ramp database with available echocardiographic images of the outflow cannula, high systolic slope value (>1200 cm/s2) identified the patient with clinical recovery leading to successful LVAD decommission.