Impact of Time Course of LVAD-Mediated Reverse Remodeling on Post Explantation Long-Term Sustainability of Favorable Clinical Response: Insights from RESTAGE-HF

Abstract

<h3>Purpose</h3> The RESTAGE-HF multicenter study demonstrated high rates of myocardial recovery after combining LVAD support with HF pharmacological therapy and regular cardiac function monitoring protocol. We sought to investigate whether the time course of LVAD-mediated reverse remodeling impacts the post-explantation long-term sustainability of myocardial recovery. <h3>Methods</h3> We studied 36 HeartMate II LVAD patients with advanced non-ischemic dilated cardiomyopathy who completed the study protocol. LVAD explantations occurred when patients met the reverse remodeling criteria with the LVADs turned-down to minimum speed: LVEF >45%, left ventricular end diastolic diameter (LVEDD)<60mm, left ventricular end systolic diameter <50mm, pulmonary capillary wedge pressure ≤15mmHg and cardiac index >2.4 L/min/m2. We investigated whether meeting these criteria <6 months, between 6-12 months or after >12 months post-LVAD support impacted long-term sustainability of the myocardial structural and functional response or long-term survival free of Transplant (Tx) or LVAD. <h3>Results</h3> Nineteen patients (53%) met criteria and underwent LVAD explantation. Patients explanted at <6, 6-12 and >12 months post-LVAD were 2 (10.5%), 9 (47.4%) and 8 (42.1%), respectively. There were no significant differences (p=0.80) in the survival free of Tx or LVAD at 1, 3, and 5 years post-LVAD removal between patients explanted at <6, 6-12 and 12 months (<b>Figure 1A</b>). Furthermore, the time course of reverse remodeling also did not significantly impact the long-term stability of post-explantation LVEF and LVEDD at 1, 3 and 5 years (<b>Figures 1B and 1C</b>). <h3>Conclusion</h3> In RESTAGE-HF multicenter study the time course of reverse remodeling during LVAD support did not appear to impact the long-term sustainability of the post-explantation favorable clinical response either in terms of long-term survival free of HF recurrence or stability of the improved cardiac structure and function.