Explantation of INCOR left ventricular assist device after myocardial recovery.
OBJECTIVE
Myocardial recovery in patients supported by the INCOR left ventricular assist device (LVAD; Berlin Heart GmbH, Berlin, Germany) is seen in 5% of patients on this device worldwide. We describe improved surgical techniques for INCOR LVAD explantation.


METHODS
The outcome of INCOR LVAD implantation at our center and the operative techniques of device explantation were studied. The patients weaned from the device were followed up.


RESULTS
Out of 121 patients supported by the device, five (4.1 %) were weaned from the device, whereas 34 patients (28.1 %) underwent heart transplantation. In explantation surgery, the inflow cannula was removed (one case) or remained in the left ventricle after occlusion with an inflow cannula plug, with transection of the inflow cannula at its curve (two cases) or without transection (two cases). When the inflow cannula was occluded without the support of cardiopulmonary bypass (two cases), operative time (180 min and 210 min) was shorter than that with other explantation procedures. After mean follow-up of 2.4 years (range two months-four years) after device explantation, all five patients are alive, have not required heart transplantation and are in New York Heart Association class I (one case) or class II (four cases). After weaning from the device, no cerebrovascular complication was observed in any of the five patients.


CONCLUSIONS
There is a possibility of weaning after INCOR implantation and surgical techniques for the removal of the INCOR LVAD should be further developed.
Komoda
Takeshi
T
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany. komoda@dhzb.de
Komoda
Satsuki
S
Dandel
Michael
M
Weng
Yuguo
Y
Hetzer
Roland
R
D000328:Adult; D006348:Cardiac Surgical Procedures; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods; D006333:Heart Failure / Q000503:physiopathology; D006352:Heart Ventricles / Q000294:innervation*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies