455 Long-term follow up of left ventricular size and function in patients successfully bridged to recovery after left ventricular assist device support

Abstract

Ventricular assist devices (VADs) have traditionally been viewed as a bridge to transplant (BTT) for patients in decompensated heart failure. A subset of patients implanted with VADs will develop enough myocardial recovery to allow weaning and explantation of their devices. However, it is unclear what happens to left ventricular size and function in patients successfully bridged to recovery post LVAD explant. From 2002 to 2011, 70 patients have undergone VAD implantation at our institution. A retrospective review including all implanted patients was performed. Of these, 10 patients (14%) have recovered myocardial function enough to allow explantation. Of the explanted patients, 7 underwent isolated left ventricular assist device (LVAD) implantation, 2 underwent right ventricular assist device implantation, and one underwent biventricular assist device implantation. Only the patients who underwent isolated LVAD implantation and subsequent explantation were included in this analysis. The majority of these patients (86%) were implanted with a continuous flow rather than pulsatile flow device. Eighty-six percent of patients had non-ischemic heart failure and the most common etiology of heart failure amongst successfully weaned patients was acute myocarditis (43%) and dilated cardiomyopathy (43%). Mean and median duration of symptoms prior to implantation were 78 and 30 days, respectively, with the majority of patients presenting with new onset heart failure (71%). Mean duration of support prior to explantation was 180 days. At mean follow-up of 697 days, all 7 patients were alive and had NYHA I functional class. The table provides baseline and post-explant characteristics of all explanted patients. All patients had severe left ventricular (LV) dysfunction with mean LV ejection fraction (EF) 16% prior to implantation. LVEF significantly improved at the time of explantation (52%) and remained stable at last follow-up (50%). LV end-diastolic dimension (LVEDD), however, increased from 42 mm at explantation to 52mm at last follow-up (Table).Tabled 1 We show that VADs may facilitate myocardial recovery and be used as a bridge to recovery in a subset of patients who require mechanical circulatory support for decompensated heart failure. Despite LV dilation post LVAD explant, the improvement in left ventricular function achieved by VAD support appears to remain stable over time with sustained symptomatic improvement.