Predictors of Long-Term Success after Successful Explantation of Continuous Flow Left Ventricular Assist Device Support: The University of Tokyo Experience

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

Methods: We retrospectively identified a total of 135 adult patients with cf-LVAD therapy as bridge to heart transplant due to dilated cardiomyopathy. Of those, 13 patients underwent device explantation (recovery group) after myocardial recovery. 12 (92%) of the explanted patients were evaluated using our weaning protocol (First phase; selection of weaning candidates at clinic visit, Second phase; cf-LVAD speed reduction and saline loading test, Third phase; intraoperative outflow graft occlusion test) and underwent surgical explantation. Meanwhile, the remaining 122 continued with cf-LVAD therapy (nonrecovery group).

Results: 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 six months postoperatively. The 13 explanted patients are currently alive at a median of 30 (IQR; 18–58) months after explantation. The survival rate free from re-hospitalization due to heart failure following explantation was 100%. Left ventricular function and remodeling after explantation were also preserved.

Conclusion: In nonischemic 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.

Publication History

Article published online:
13 February 2024