Use of LVAD in Left Ventricular Non-Compaction

Introduction Congestive heart failure from left ventricular non-compaction (LVNC) can present with thromboembolic complications and cardiac arrhythmias. These challenges have resulted in a very cautionary approach regarding implantable left ventricular assist devices (LVADs) in these patients. However, due to continued limitation for donor heart availability, LVAD therapy has been used in selected patients. The aim of this study was to assess the outcomes of LVAD therapy in patients with LVNC. Methods Of 244 total LVAD patients between June 2013 and March 2017, retrospective analysis was performed on 17 patients with LNVC. Primary endpoint for this study was freedom from pump thrombosis at 12 months. Secondary outcomes included in-hospital mortality, 30-day mortality and burden of arrhythmias post LVAD implant. Results 11 out of 17 patients (65%) were males and 11 patients (65 %) were African Americans. 1 patient (5.88%) had pump thrombosis and underwent pump exchange. 30-day survival was 100%, while in-hospital mortality occurred in 1 patient (6%). Right ventricular failure (RVF) was noted in 9 patients (53%) either requiring >2 weeks of inotropic support or a placement of a temporary right ventricular assist device. Freedom from pump thrombosis at 12 months was 94%. One patient (6%) had a significant increase in arrhythmia burden post LVAD implantation. Conclusion LVAD therapy for patients with LVNC appears safe with 30 day and in-hospital mortality similar to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) data. While RVF rates are formidable suggesting biventricular involvement, problems with pump thrombosis and ventricular arrhythmias appears to be minimal.