title: Successful weaning and explantation of the Heartmate II left ventricular assist device.
abstract: BACKGROUND
  Ventricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre.
  
  
  METHODS
  Patients who had a VAD explanted were identified in the mechanical support institutional database and their outcomes were analyzed. Clinical examinations, biochemical markers, and serial echocardiograms were used to demonstrate myocardial recovery.
  
  
  RESULTS
  Seventeen patients had a Heartmate II VAD inserted between 2008 and 2010. Four patients underwent successful weaning and subsequent VAD explantation. Etiology of decompensated heart failure was idiopathic dilated cardiomyopathy (n = 1), ischemic (n = 1), or myocarditis (n = 2). Mean age was 35.3 years. Patients were supported for 213 days (range 70-293 days) and were in New York Heart Association class I in the community before explantation. The devices were explanted via a minimally invasive approach, without cardiopulmonary bypass. All patients survived explantation and were discharged alive from hospital after an average of 5.7 ± 1.5 days post pump explantation. No adverse events were reported after explantation. Only one patient required allogenic blood transfusion after the procedure.
  
  
  CONCLUSIONS
  Patients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada. yoanlamarche@gmail.com
authors: Yoan
authors: Y
authors: Lamarche
authors: Mark
authors: M
authors: Kearns
authors: Kiranbir
authors: K
authors: Josan
authors: Jamil
authors: J
authors: Bashir
authors: Andrew
authors: A
authors: Ignaszewski
authors: Annemarie
authors: A
authors: Kaan
authors: Jennifer
authors: J
authors: Kealy
authors: Robert
authors: R
authors: Moss
authors: Anson
authors: A
authors: Cheung