Abstract 12417: Left Ventricular Assist Device Reimplantation for Recurrent Heart Failure After Myocardial Recovery and Weaning
In our experience, 5-10% of patients with dilative cardiomyopathy have presented myocardial recovery and could be weaned from long-term support with left ventricular assist device (LVAD). However, one third of them had a heart failure recurrence during follow-up. Subsequent treatment options are limited to heart transplantation or reimplantation of LVAD. We evaluated clinical outcome of the patients treated with LVAD reimplantation.
Methods: Between 1995 and 2014, 64 patients implanted with LVAD for dilative cardiomyopathy (median age 43, range 16-71 years) were weaned from LVAD according to our institutional protocol. Among them, six patients required later reimplantation of LVAD due to recurrent heart failure. Hospital records were retrospectively reviewed.
Results: LVAD reimplantation in the six patients was necessary at a median of 1638 (range, 393-5336) days after weaning from the first LVAD. Actual median duration of freedom from heart failure recurrence (from date of weaning from first LVAD until readmission due to recurrent heart failure) was 1399 (range, 385-5284) days. NYHA functional class remained at I or II in all patients during this time. The operation time, ventilation time and ICU stay for 2nd LVAD implantation were not longer than for 1st implantation (255±59 vs. 232±57 min, p=0.465; 9±9 vs. 7±12 days, p=0.747 and 14±8 vs. 17±25 days, p=0.841, respectively.). Two patients died after the 2nd LVAD implantation (after 409 and 1190 days) and one patient died 1 day after subsequent heart transplantation (817 days on 2nd LVAD support). The other three patients are still on support (54, 782 and 1356 days).
Conclusion: Weaning from LVAD according to a strict protocol is justified considering the median device-free time of over 4 years without heart failure symptoms. LVAD reimplantation after heart failure recurrence is a feasible treatment option, with mortality comparable with that of primary LVAD support.
Author Disclosures: T. Saito: None. M. Dandel: None. Y. Weng: None. E. Potapov: None. T. Krabatsch: None. R. Hetzer: None.
- © 2014 by American Heart Association, Inc.