Long-Term Outcomes of Heartware Left Ventricular Assist Device Decommissioning for Myocardial Recovery

Abstract

Left ventricular assist device (LVAD) decommissioning reduces the risks associated with long-term LVAD support without subjecting patients to a major explantation operation. However, the long-term outcomes of this strategy are not known. Our unit's LVAD database was reviewed to identify patients who underwent LVAD decommissioning for myocardial recovery from 2009 to 2019. Friedman test was performed to compare left ventricle (LV) function grades over time and repeated measures ANOVA for ejection fraction (EF). Kaplan-Meier analysis was conducted to compare the survival of these patients with the LVAD bridged to transplant and all other LVAD patients. Among the 254 adult LVAD patients, 11 (4.3%) underwent decommissioning for myocardial recovery after assessment at low flow. The median support duration was 940 (IQR 646-1078) days and median follow-up duration 1425 (IQR 776-1774) days. 3 patients (27.3%) died during follow-up, 1 due to heart failure and 2 due to sepsis. 4 patients (36.4%) had LVAD explantation subsequently due to recurrent sepsis. This group's survival was comparable to that of the LVAD bridged to transplant group (p=0.7) and significantly better than that of the all other LVAD group (p=0.0015) (Figure 1). However, after decommissioning, their LV function gradually deteriorated (Figure 2). Selected patients with myocardial recovery would benefit from LVAD decommissioning with favourable long-term outcomes. However, they still face the potential risk of systemic infection and need to be regularly followed up for LV function monitoring and medical therapy optimisation.