title: Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: Results from the United Network for Organ Sharing database.
abstract: BACKGROUND
  Mechanical circulatory support (MCS) leads to favorable changes in the failing heart at the molecular, cellular, and structural levels. However, myocardial recovery leading to device explantation is rare. We reasoned that the multicenter United Network for Organ Sharing (UNOS) registry might provide insights into clinical predictors and outcomes of the recovery process.
  
  
  METHODS
  The MCS device data set of the UNOS registry was queried for patients with long-term continuous-flow left ventricular assist devices (CF-LVADs) that were explanted for heart transplantation or indication of recovery. Analysis was restricted to adult patients (≥18 years old) who were listed for an initial heart transplantation. Patients with CF-LVADs that were explanted because of recovery were compared with patients with CF-LVADs who underwent transplantation.
  
  
  RESULTS
  We identified 594 patients with HeartMate II devices and 92 patients with HeartWare devices. Duration of support was on average 500.4 ± 325.3 days. In 34 (5.0%) patients, devices were explanted secondary to myocardial recovery. Univariate predictors of recovery in patients with long-term LVADs included younger age (40 years vs 53 years), female sex, lower body mass index (25.7 kg/m(2) vs 27.9 kg/m(2)), non-ischemic etiology (91% vs 59%), lack of implantable cardioverter defibrillator at the time of listing (44% vs 79%), and lower serum creatinine (0.97 mg/dl vs 1.28 mg/dl) (all p < 0.05). In the post-explantation period, freedom from death or transplantation was 66% at 1 year.
  
  
  CONCLUSIONS
  The incidence of recovery on device support is low in the current MCS era and limited to a select cohort of predominantly young patients with non-ischemic myopathy. Given the high incidence of disease recurrence, patients should be closely followed after device explantation.
authors.affiliation: Division of Cardiology.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pan
authors.affiliation: Division of Cardiology.
authors.forename: Baran
authors.initials: B
authors.lastname: Aksut
authors.affiliation: Division of Cardiology.
authors.forename: Omar E
authors.initials: OE
authors.lastname: Wever-Pinzon
authors.affiliation: Division of Cardiology.
authors.forename: Shaline D
authors.initials: SD
authors.lastname: Rao
authors.affiliation: Division of Cardiology.
authors.forename: Allison P
authors.initials: AP
authors.lastname: Levin
authors.affiliation: Division of Cardiology.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Garan
authors.affiliation: Division of Cardiology.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Fried
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center-New York Presbyterian, New York, New York.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center-New York Presbyterian, New York, New York.
authors.forename: Takayama
authors.initials: T
authors.lastname: Hiroo
authors.affiliation: Division of Cardiology.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: Division of Cardiology.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center-New York Presbyterian, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiology.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology. Electronic address: vt2113@cumc.columbia.edu.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D011379:Prognosis; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
keywords: UNOS registry; device explantation; heart transplant; left ventricular assist device; mechanical circulatory support; recovery