Long-term outcome in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices

Objectives: Since our first successful weaning from a left ventricular assist device (LVAD) of a patient with idiopathic dilated cardiomyopathy (DCM) in March 1995 we have shown that for selected patients with DCM weaning is a feasible option. After nearly 9 years of experience we assessed the long-term results of all weaned patients.

Material and Methods: We evaluated all patients with DCM weaned between 3/1995 and 9/2003 with regard to preservation of stable cardiac function without LVAD support and survival after weaning.

Results: The 33 weaned DCM patients showed survival of 85% at 5 years after LVAD explantation. Sustained cardiac recovery for more than 2 years after weaning was documented in 64.3%. At 5 years after LVAD removal, despite worsening of cardiac function in a small number of patients, 75% still had their native hearts, without any need for transplantation or another LVAD. Recurrence of heart failure (HF) within the first 2 years occurred in only 32.3% of patients. Only one patient died after weaning due to HF; the other patients with HF recurrence were successfully transplanted. Three patients (9.6%). died after weaning due to non-cardiac causes. At present, 3 of the 4 patients weaned in 1995 are still almost asymptomatic (NYHA class I-II) and show good cardiac function (LVEF ≥ 50%).

Conclusions: For selected patients with DCM, weaning from LVADs is a clinical option with potentially successful results for over more than 5 years and should therefore be considered in all patients with sufficient recovery of cardiac function after LVAD implantation.