title: Ventricular reconditioning and pump explantation in patients supported by continuous-flow left ventricular assist devices.
abstract: BACKGROUND
  The potential for myocardial reconditioning and device explantation after long-term continuous-flow left ventricular assist device (LVAD) support presents an opportunity to delay or avoid transplantation in select patients.
  
  
  METHODS
  Thirty of 657 patients with end-stage heart failure supported with continuous-flow LVADs were assessed for device explantation. Each patient underwent an individualized process of weaning focused on principles of ventricular unloading, gradual reconditioning, and transition to medical therapy.
  
  
  RESULTS
  After varying reconditioning periods, 27 patients (16 men, 11 women; age, 39 ± 12 years) underwent LVAD explant, and 3 patients (2 men, 1 woman; age, 22 ± 6 years) were evaluated for explantation but could not be weaned. The duration of LVAD support was 533 ± 424 days (range, 42-1,937 days) for the explant cohort and 1,097 ± 424 days (range, 643-1,483) for the non-explant cohort. The LV end-diastolic dimension, LV ejection fraction, systolic pulmonary artery pressure, cardiac output, and cardiac index in the explant cohort were significantly improved at explantation (all, p < 0.05). Two late deaths occurred after LVAD explantation despite satisfactory native cardiac function, and 1 patient required resumption of LVAD support 2.7 years after device removal. The remaining explant patients remain in New York Heart Association classes I to II with medical management alone (mean survival post-explant, 1,172 ± 948 days). The 3 candidates who could not be weaned ultimately underwent transplantation.
  
  
  CONCLUSIONS
  The potential for recovery of native LV function after long-term continuous-flow LVAD support should encourage a more aggressive approach to ventricular reconditioning with the goal of device explantation and a return to medical management, particularly in young patients with dilated cardiomyopathy.
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas. Electronic address: ischwenke@texasheart.org.
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: Andrew C W
authors.initials: AC
authors.lastname: Baldwin
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: Zumrut T
authors.initials: ZT
authors.lastname: Demirozu
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Segura
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernandez
authors.affiliation: Department of Internal Medicine, Division of Cardiology, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Taegtmeyer
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: Hari
authors.initials: H
authors.lastname: Mallidi
authors.affiliation: Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D020878:Device Removal; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents
keywords: heart failure; left ventricular assist device (LVAD); ventricular reconditioning; ventricular recovery; ventricular unloading