Characteristics of LVAD Turn-Down Study to Predict Myocardial Recovery and Successful LVAD Decommissioning

Abstract

<h3>Purpose</h3> Myocardial recovery after left ventricular device (LVAD) implantation is important to identify; however, identifying predictors of successful LVAD decommissioning, and recurrence of heart failure remains a challenge. <h3>Methods</h3> We performed a retrospective analysis on individuals who underwent a protocolized echocardiographic and invasive hemodynamic turn-down study. Patients were selected based on normalized hemodynamics, clinical stability and LVEDD <5.5 cm. <h3>Results</h3> A total of 12 patients underwent the LVAD weaning protocol. Of those patients, 42% (5/12) underwent LVAD decommissioning with sustained recovery (SR) (median 13 months) while 58% (7/12) failed recovery (FR) by requiring LVAD re-implantation after decommissioning or failed turn-down study precluding LVAD decommission. In FR versus SR patients LV-end systolic (LVESD) and -end diastolic (LVEDD) diameter were higher at the start (LVESD 4.8 ± 0.4 FR vs 3.5 ± 0.3 SR, p<0.05, Fig A; LVEDD 5.3 ± 0.3 FR vs 4.5 ± 0.2 mm SR, p = 0.066, Fig C) and end (LVESD 4.6 ± 0.5 FR vs 3.2 ± 0.3 mm SR, p<0.05, Fig B; LVEDD 5.4 ± 0.3 FR vs 4.6 ± 0.2 mm SR p = 0.10, Fig D) of the turn-down. Ejection fraction did not differ at start or end of the turn-down study between groups (Fig E,F). Hemodynamic parameters of right heart function differed between FR and SR patients. Central venous pressure (CVP) increased in the FR group through the turn-down study, whereas CVP decreased or did not change in the SR group (∆CVP 1.5 ± 0.8 FR; -1.0 ± 0.4 mmHg SR, p<0.05; Fig G). Pulmonary artery pulsatility index (PAPI) decreased in FR patients at the end of turn-down study, whereas PAPI increased in those with SR (∆PAPI -0.6 ± 0.2 FR; 0.6 ± 0.5 mmHg SR, p<0.05; Fig H). LVAD power prior to LVAD turn-down was higher in FR relative to SR patients (4.1 ± 0.3 FR; 2.9 ± 0.3 W SR, p<0.05, Fig I). <h3>Conclusion</h3> In our cohort of LVAD turn-down studies, we were able to identify echo parameters, invasive hemodynamics, and LVAD pump parameters that differed between patients with failed and sustained recovery.