Contemporary Outcomes after Durable Left Ventricular Assist Device Explantation in Patients with Evidence of Cardiac Recovery

Purpose In patients with durable left ventricular assist devices, cardiac recovery allowing device explanation is a rare and poorly understood phenomenon. The aim of this study was to describe the clinical features and outcomes of patients with cardiac recovery who underwent LVAD explantation or decommission with no formal recovery protocol at two large academic medical centers. Methods We identified all patients with nonischemic cardiomyopathy (NICM) with a continuous flow durable LVAD implanted at two centers through 2017 who had evidence of cardiac recovery as determined by a multidisciplinary assessment of cardiac surgeons and heart failure specialists, and underwent either explant of the LVAD or its decommission (turned off but left in-situ). Clinical, laboratory, echocardiographic features, and outcomes were analyzed. Results Twenty individuals met entry criteria. Indications for LVAD explant/decommission included pump thrombosis (45%, N=9/20), driveline infection (30%, N=6/20), or cardiac recovery without concurrent LVAD complication (25%, N=5/20). The average age at LVAD explant/decommission was 41±13 years and the median duration of support was 656 (265-1,089) days. The average left ventricular ejection fraction (LVEF) was 13±4% at implant, 45±11% at explant/decommission, and 32±18% at last-follow-up. There were 4 deaths (3 within 369 days) and 5 LVAD reimplantations (4 within 16 days and 1 at 62 days) over 12,986 person-days of follow-up after explant/decommission. Only 15% of the total cohort (N=3/20) had sustained LVEF recovery (Figure). Conclusion A minority of patients with NICM who had evidence of cardiac recovery allowing LVAD explant/decommission maintained their improved function. In nearly one-half of patients, regression in cardiac function was catastrophic and resulted in death or required reimplantation of a durable LVAD. These observations highlight the need to better define predictors allowing safe withdrawal of durable LVAD support.