Long-term Safety of Minimally Invasive LVAD Discontinuation for Myocardial Recovery

Abstract Background Left ventricular assist devices (LVAD) play important roles in advanced heart failure (HF) management. In patients who experience myocardial recovery, the LVAD is often explanted via a resternotomy, which may negatively impact the newly recovered heart. We describe a case-series of LVAD discontinuation using a minimally-invasive approach, focusing on thromboembolic phenomenon and infection rates in long-term follow-up. Methods Our study is a single-center, retrospective case series of patients with myocardial recovery after mechanical unloading with an LVAD. Patients underwent outflow graft ligation through a minimally invasive approach with driveline excision. Post-discontinuation, patients obtained serial transthoracic echocardiograms for a minimum of 6 months and followed with our heart failure specialist. Results All seven recovery patients had non-ischemic cardiomyopathy and included 4 female patients (57%). Mean age was 44.3 +/- 15.6 years. Median LVAD support duration was 454 days (IQR 326 to 1096). ICU and total length of stays were 3.4 +/- 1.9 and 6.3 +/- 2.3 days, respectively. Blood transfusion rate was 0.86 +/- 1.1 units. In median follow-up of 874 days (IQR 864 to 1007), no patients developed thromboembolic phenomena despite use of aspirin only for prophylaxis. One patient experienced driveline infection, who had persistent driveline infection prior to procedure. Conclusions This minimally-invasive approach for LVAD discontinuation through outflow graft ligation, driveline removal and LVAD stoppage in setting of myocardial recovery avoids resternotomy risks. Despite leaving the LVAD in situ , risks of thromboembolism from residual hardware as well as infection risk to the inflow/outflow cannulas have not been evident.