Abstract 1766: Identifying Ventricular Recovery on Chronic Mechanical Circulatory Support: Clinical Approach and Outcome Following Device Removal
Background: The left ventricular assist device (LVAD) is typically used as a bridge to transplant for patients with severe heart failure. LV recovery may occur in a subset of patients; however, a clinical approach to identify LV recovery has not been well described.
Objectives: To test the hypothesis that LV recovery may be identified on LVAD using non-invasive measures of LV function, and that device removal may be associated with favorable long-term outcome.
Methods: We studied 45 patients, aged 44±17 yrs, with onset of heart failure < 6 months before LVAD; all originally as a bridge to transplant. Duration of support was 203±161days. Automated border detection echocardiography and noninvasive blood pressure were used on-line at full LVAD flow and during periods of reduced flow (half flow to minimal flow, if tolerated). LV fractional area change and preload-adjusted maximal power (peak pressure × peak flow)/(end-diastolic area)3/2 were calculated.
Results: Fifteen patients had LV recovery with successful LVAD removal, 30 remained LVAD dependent. LV recovery was predicted by a fractional area change > 34% (100% sensitivity, 87% specificity), and preload-adjusted maximal power > 4.0 mW/cm4 (93% sensitivity, 93% specificity) on minimal LVAD flow. On follow-up, 2 had heart failure at 6 mo. and were transplanted, 1 with a normal ejection fraction had sudden death at 1 mo., and 1 died from a non-cardiac cause (sepsis); 11 patients (73%) were alive and free from heart failure 4 ± 2 yrs after LVAD removal.
Conclusion: LV recovery may be identified in patients on LVAD noninvasively, and device removal associated with a favorable long-term outcome.