Abstract 15771: Recovery of Left Ventricular Function on Lvad Support is Associated With Improved Outcomes

Abstract

Introduction: For select patients, support with a left ventricular assist device (LVAD) can be used as a bridge to recovery of ventricular function. While rates of explant are low, improvement of left ventricular ejection fraction (LVEF) on LVAD support is more common. Hypothesis: We hypothesize that LVAD recipients whose LVEF recovers have better outcomes compared to those whose LVEF does not recover. Methods: Data from INTERMACS was merged with the Duke Echo Lab Database for all patients who underwent LVAD implantation between March 2006 and June 2017 at Duke Hospital. 286 patients with a continuous flow LVAD also had serial echocardiograms performed. Based on our prior work in HFrEF, we defined recovery as an LVEF >= 40%. INTERMACS data and manual chart review was used to identify hospitalizations for recurrent heart failure (HF), gastrointestinal bleeding (GIB), and pump thrombosis along with mortality. Results: 9.8% of patients had an LVEF >= 40% within 2 years of implant. LVEF recovery was associated with female gender [53.6% vs 21.7%. p < 0.001], lower serum Cr prior to implant [1.30 mg/dL (IQR 1.00-1.60) vs 1.40 mg/dL (IQR 1.10-1.90), p = 0.05], and absence of an ICD [53.6% vs 79.8%, p = 0.002]. Within 1-year of the follow-up echo with the highest reported LVEF, patients whose LVEF was >= 40% had a reduced incidence for a composite of hospitalizations for HF, GIB, pump thrombosis, and mortality [12.8% vs 39.8%, p = 0.013] as well as reduced rate of recurrent composite endpoint events [4.7 vs. 49 events per 100 person years, p = 0.020]. Of the individual endpoints, subjects with an LVEF >= 40% had a lower, but non-significant, incidence of hospitalizations for HF [0% vs 10%, p = 0.122] and GIB [4.8% vs 18.2% p = 0.081]. Importantly, those who went on to recover their LVEF did not have a lower rate of recurrent composite endpoint events between the time of implant and time to follow-up echo (88 events per 100 person years in the recovery group vs 53 per 100 person years in the non-recovery group, p =0.052), suggesting that recovery of LVEF is temporally related to the improvement in outcomes. Conclusions: Recovery of LVEF on LVAD support in not uncommon. Strategies to facilitate recovery have the potential to improve outcomes of LVAD recipients beyond pump explant.