Long-Term Outcome of Patients after Successful LVAD Explant: A EUROMACS Study

Abstract

Purpose In patients supported by a left ventricular assist device (LVAD) myocardial recovery resulting in explant occurs in approximately 1-2%. However, the long-term outcome of these patients is unknown. We studied the clinical management and long-term outcomes in patients after LVAD explant. Methods An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying patients > 18 years old with successful LVAD explant. Baseline characteristics were retrieved and follow-up (FU) of patients after explant was collected. A Kaplan-Meier analysis was performed for the event-free survival (EFS), events being LVAD reimplantation or heart transplantation. Results A total of 49 (1.4%) patients with successful LVAD explant were identified in EUROMACS. FU was acquired of 28 (57%) of the patients: median age 43y (range 18-64), 23 (82%) males, median LVEF was 18% (IQR 13-23%) at the time of LVAD implantation, 60.7% were INTERMACS class 1 or 2. Etiologies of heart failure (HF) were: dilated cardiomyopathy (DCMP) due to myocarditis (9), idiopathic DCMP (6), ischemic (3) or others (10). Devices implanted: 14 HeartMate II (50%), 11 HeartWare VAD (39%), 2 HeartMate 3 (7%), 1 unknown, with a mean duration of support of 13.5 months (range 1 - 42). Mean FU after explant was 27 months (±23). Use of HF medication was: ACE inhibitor 71%, β-blockers 85% and loop diuretics 50%. New York Heart Association (NYHA) class is I to II in 82% and III in 11% of these patients. Aspirin was used by 43% of the patients, 39% used warfarin, with 29% using neither of them. The inflow cannula was in situ in 3 (11%) patients, while no cerebrovascular accident was seen. EFS was 92.9% after 4 years. One patient required reimplantation after 32 days, and 1 died of sepsis 10 months after LVAD explant. Conclusion This EUROMACS FU study is, to our knowledge the first in the literature, and shows that long-term EFS after LVAD explant is excellent, with the majority of the patients having only mild to moderate HF symptoms.