Excellent Long-Term Survival After Weaning from Durable Ventricular Assist Device

Abstract

<h3>Purpose</h3> It is reported that bridge to recovery was achieved in a limited number of cases after durable ventricular assist device (VAD). Thus, long-term survival over 5 years after removal of the device is not thoroughly examined. We aim to analyze long-term results and the trend of left ventricular (LV) function after weaning from a durable VAD in our hospital. <h3>Methods</h3> Since September 2006, 344 durable VAD implantations were performed in the University of Tokyo Hospital, among which 30 patients were successfully weaned from the device. Twenty-five patients were enrolled in this study after excluding 5 patients who were treated for fulminant myocarditis. The majority of causative disease was idiopathic dilated cardiomyopathy in 24. They were implanted with paracorporeal (n = 12) or implantable (n = 13) VAD according to a reimbursement policy. Aggressive pharmacological treatment including titration of beta-blocker and ACE inhibitor or ARB along with aerobic rehabilitation was planned in all cases. Once a sign of functional recovery was recognized, our weaning protocol was initiated, such as cardiopulmonary exercise testing, VAD off-test and volume challenging test. Twenty-five patients met the weaning criteria, and underwent a VAD removal via redo median sternotomy. Long term survival was examined including repeated VAD implantation. Analysis of LV diastolic dimension and ejection fraction by echocardiography and BNP level was conducted to monitor LV function. <h3>Results</h3> Patients were weaned from the VAD after 333-day-long support without in-hospital death. All patients were followed-up for an average of 6 years. One-, 5-, and 10-year survival was 100%, 89.7% and 89.7%, and re-VAD-free survival was 91.8%, 85.7% and 85.7%, respectively. Notably, there was no death in patients who were weaned from implantable VAD. LVDd (67.7 mm) was significantly reduced before weaning (52.3 mm) and stabilized for a year. LVEF (19.5%) was significantly improved before weaning (43.4%) and further increased toward 1 year. BNP was significantly reduced before weaning and in the same level at 1year. <h3>Conclusion</h3> Long-term prognosis of patients who were weaned from durable VAD through our structured protocol was excellent. Bridge to recovery seems to aggressively be reappraised as a vital choice for durable VAD treatment.