Abstract 3380: Heart Failure Reversal by Ventricular Unloading in Patients With Chronic Cardiomyopathy: Criteria for Weaning From Ventricular Assist Devices
Background Unloading-promoted reversal of heart failure (HF) which allows ventricular assist device (VAD) removal without transplantation was repeatedly reported. However, because few patients with chronic cardiomyopathy (CCM) were weaned form VADs and most of them only recently, the reliability of criteria used for weaning decisions to predict long-term successes of VAD removal is barely known. After 14 years of weaning experience we assessed this issue.
Methods In 44 patients aged >14 years with CCM as the underlying cause for HF, who were weaned from bridge-to-transplant designed VADs since 1995, we analyzed data on cardiac morphology and function collected before VAD implantation, echocardiographic parameters recorded during pre-explantation “off-pump” trials, duration of HF before VAD implantation and stability of recovery before and early after VAD removal.
Results Post-weaning 10-year transplant-free survival reached 64%. Only 5 patients (11.4%) died due to HF recurrence or weaning-related complications. Pre-explantation “off-pump” LVEF of ≥50% and ≥45% revealed predictive values for cardiac stability lasting ≥5 years after VAD removal of 91.7% and 79.1%, respectively. With each percent of LVEF reduction, the risk for HF recurrence became 1.5 times higher. The predictive value of LVEF ≥45% became >90% if the additional parameters pre-explantation LV size and geometry, stability of unloading-induced morphological and functional improvement before VAD removal and HF duration before VAD implantation were also considered. Definite cut-off values for the parameters used in different combinations allowed formulation of weaning criteria with high predictability for post-weaning stability, also in patients with incomplete cardiac recovery. Pre-explantation LV systolic wall motion peak velocity (Sm) of ≥8cm/s (basal posterior wall) also showed high predictive value (86.7%) for ≥5 year post-weaning stability.
Conclusions VAD removal in CCM patients is feasible and can be successful for >14 years even after incomplete cardiac recovery. Parameters of pre-explantation cardiac function, LV size and geometry and HF duration in combination allow detection of patients with the potential to remain stable for >5 years after VAD removal.