Incidence, Outcomes, and Opportunity for Left Ventricular Assist Device Weaning for Myocardial Recovery.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 101598241 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2213-1787 (Electronic) Linking ISSN: 22131779 NLM ISO Abbreviation: JACC Heart Fail Subsets: MEDLINE
    • Publication Information:
      Original Publication: New York, NY : Elsevier, [2013]-
    • Subject Terms:
      Heart-Assist Devices* ; Heart Failure*/epidemiology ; Heart Failure*/therapy ; Heart Failure*/physiopathology ; Heart Failure*/surgery ; Device Removal*/statistics & numerical data; Humans ; Male ; Female ; Middle Aged ; Incidence ; United States/epidemiology ; Adult ; Recovery of Function ; Registries ; Recurrence ; Aged ; Retrospective Studies
    • Abstract:
      Background: Myocardial recovery occurs in patients with advanced heart failure on left ventricular assist device (LVAD) support, but there is the premise that it is rare with uncertain results.
      Objectives: The goal of this study was to investigate the incidence and consequence of LVAD explant after myocardial recovery.
      Methods: Using the United Network for Organ Sharing registry, LVAD implants in the United States between 2005 and 2020 were tracked until death, transplantation, or explant for myocardial recovery. The cohort undergoing explant was followed up for heart failure relapse (defined as relisting followed by delisting due to death, being too ill, or transplantation; or second durable LVAD implant).
      Results: Of 15,728 LVAD implants, 126 patients underwent explant for recovery, which only occurred in 55 (38%) of 145 implanting centers. The crude cumulative incidence was 0.7% at 2 years, whereas the incidence reached 4.7% among designated centers in the selected young nonischemic cohort. Of 126 explanted patients, 76 (60%) were subsequently delisted for sustained recovery. Heart failure relapsing had a relatively higher hazard in the early phase, with a 30-day incidence of 6% (7 of 126) but tapered following with the freedom rate of 72.5% at 4 years.
      Conclusions: In the United States, LVAD explant for myocardial recovery was underutilized, leading to a very low incidence at the national level despite a realistic rate being achieved in designated centers for selected patients. With follow-up extending up to 4 years after explant, more than one-half were successfully removed and stayed off the waitlist, and approximately 70% were free from heart failure relapse events.
      Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
      (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: end-stage heart failure; left ventricular assist device; myocardial recovery
    • Publication Date:
      Date Created: 20240126 Date Completed: 20240508 Latest Revision: 20240508
    • Publication Date:
      20240509
    • Accession Number:
      10.1016/j.jchf.2023.12.006
    • Accession Number:
      38276935