Background
Protocols have been developed to identify patients for elective withdrawal of continuous-flow
left ventricular device (cfLVAD) support. However, little is known about non-elective
explantation or decommissioning of cfLVADs.
Methods
A retrospective analysis of all patients who underwent left ventricular assist device
(LVAD) explantation or decommissioning at a single center between 2002 and 2021 was
performed.
Results
Sixty-one patients underwent withdrawal of a cfLVAD (HeartMate II [Abbott] n = 17, HeartMate 3 [Abbott] n = 2, HeartWare HVAD [Medtronic] n = 36, INCOR [Berlin Heart] n = 6). The median follow-up after withdrawal was 1,039 days. The survival at 5 years
was 76.1% (95% CI: 64.2%-95.2%). Predictors of worse outcomes in univariate regressive
analysis were the duration of heart failure and the age at LVAD implantation. Of the
61 patients, 40 underwent elective withdrawal following a specific protocol. The other
twenty-one patients underwent non-elective withdrawal of the cfLVAD because of device
infection (n = 12), device thrombosis (n = 6), device malfunction (n = 2) or due to acute intracerebral bleeding (n = 1), also with an excellent survival at 5 years of 81.3%. (95% CI: 63.8-1). The
withdrawal was performed in these patients even though they did not fulfill established
criteria for successful explantation or decommissioning like clinical stability (n = 21), left ventricular end-diastolic diameter ≤ 55 mm (n = 3), performance of right heart catheterization (n = 6), or pulmonary artery wedge pressure ≤ 15 mm Hg (n = 3).
Conclusion
Non-elective withdrawal is possible in selected patients after discussion in a team
of experienced cardiac surgeons, cardiologists, technicians, and VAD coordinators.
The appropriate preoperative assessment before decommissioning or explantation of
a cfLVAD warrants further investigation.
KEYWORDS
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Publication history
Published online: December 05, 2022
Publication stage
In Press Journal Pre-ProofIdentification
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