248 Right Ventricular Dysfunction Should Not Preclude Left Ventricular Assist Device Explantation in Patients Exhibiting Left Ventricular Recovery

Abstract

Purpose: A subset of patients implanted with ventricular assist devices (VADs) will develop enough myocardial recovery to allow explantation of their devices. Some degree of RV dysfunction is common in patients supported by LVADs. Little is known about what happens to the RV following LVAD explantation and it remains unknown whether the presence of RV dysfunction should preclude device explantation. Methods and Materials: A retrospective review was performed of all 78 patients who underwent VAD implantation at our institution from 20022011. Of these, 12 patients (15%) recovered myocardial function enough to allow explantation. Of these, the 9 who underwent isolated LVAD implantation were included in this analysis of echocardiographic features of LV and RV size and function pre and post LVAD explantation. Results: The mean age of this cohort was 35 years with the majority of patients presenting with new HF (71%) and nonischemic cardiomyopathy (86%). Patients were followed for a mean of 813 days following explantation. All patients had severe LV dysfunction at the time of LVAD implantation (mean LVEF 16%) but achieved significant recovery by the time of explantation (mean LVEF 52%). A significant proportion of patients (43%) had moderate RV dysfunction immediately pre-explantation. RV functionsignificantly improved with mean fractional area change (FAC) improving from 36.4% to 39.6% at one month post-explantation.