# Predictors of long-term success after successful explantation of continuous flow left ventricular assist device support

## TL;DR

This study identifies a time interval predictor for successful removal of heart assist devices in patients with heart failure.

## Contribution

The study identifies a specific time interval as a predictor for successful cf-LVAD explantation in non-ischaemic dilated cardiomyopathy patients.

## Key findings

- A time interval of 7 months between first heart failure event and cf-LVAD implantation predicts successful explantation.
- Patients with successful explantation showed significant improvement in left ventricular function and dimensions.
- Survival rate free from rehospitalization after explantation was 100% at a median follow-up of 30 months.

## Abstract

Predictors and evaluations of continuous flow left ventricular assist device (cf-LVAD) explantation in recovered patients remain under discussion due to lack of evidence on long-term safety and efficacy. This study summarized our experiences regarding cf-LVAD explantation in non-ischaemic dilated cardiomyopathy patients and estimated a predictor for sufficient myocardial recovery allowing left ventricular assist device explant.

We retrospectively identified 135 adult patients with cf-LVAD therapy as bridge to heart transplant due to non-ischaemic dilated cardiomyopathy. Of those, 13 patients underwent device explantation (recovery group) after myocardial recovery. Twelve (92%) of the explanted patients were evaluated using our weaning protocol and underwent surgical explantation. Meanwhile, the remaining 122 continued with cf-LVAD therapy (non-recovery group).

Multivariate logistic regression analysis revealed time interval between the first heart failure event and cf-LVAD implantation as an independent predictor for successful explantation. The optimal time interval cutoff value to predict cf-LVAD explantation was 7 months, with a sensitivity of 91.0% and specificity of 84.6%. Echocardiography in patients with successful cf-LVAD explantation showed significant improvement of left ventricular function and dimensions at 6 months postoperatively. The 13 explanted patients are currently alive at a median of 30 (interquartile range; 18–58) months after explantation. The survival rate free from rehospitalization due to heart failure following explantation was 100%. Left ventricular function and remodelling after explantation were also preserved.

In non-ischaemic dilated cardiomyopathy patients with a short interval between the first heart failure event and cf-LVAD therapy, left ventricular myocardium may recover in an early phase after device implantation.

Continuous flow left ventricular assist device (cf-LVAD) therapy successfully improves survival, symptoms, exercise tolerance and quality of life in patients with advanced heart failure (HF) and long-term mechanical circulatory support (MCS) using left ventricular assist device (LVAD) has increasingly become a treatment option, especially as life-saving procedure for drug-refractory end-stage HF with severe LV dysfunction [1, 2].