Cardiac Recovery During Long-Term Left Ventricular Assist Device Support.
The number of centers with left ventricular assist device (LVAD) research programs focused on cardiac recovery is very small. Therefore, this phenomenon has been reported in real-world multi-center registries as a rare event.



This study evaluated the incidence of cardiac recovery with an a priori LVAD implantation strategy of bridge-to-recovery (BTR) and constructed a recovery predictive model.



The study included LVAD recipients registered in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Cardiac recovery was evaluated in BTR and non-BTR patients. A weighted score was derived and externally validated in patients of the Utah Cardiac Recovery (UCAR) program.



Of 15,138 INTERMACS patients, cardiac recovery occurred in 192 (1.3%). The incidence of recovery was 11.2% (n = 14) in BTR compared with 1.2% (n = 178) in non-BTR patients (p < 0.0001). Independent predictors of recovery included: age <50 years, non-ischemic cardiomyopathy, time from cardiac diagnosis <2 years, absence of ICD, creatinine ≤1.2 mg/dl, and LVEDD <6.5 cm (c-index: 0.85; p < 0.0001). A weighted score termed I-CARS, effectively stratified patients based on their probability of recovery. I-CARS was validated in the UCAR cohort (n = 190) with good performance (AUC: 0.94; 95% CI: 0.91 to 0.98). One-year survival after LVAD explantation, available in INTERMACS for 21 (11%) patients, was 86%.



The incidence of cardiac recovery is higher in patients implanted with an a priori BTR strategy. We developed a simple tool to help identify patients in whom recovery is feasible. In BTR patients with favorable characteristics, I-CARS suggests a 24% probability of successful LVAD explantation. Large-scale studies to better address post-explantation outcomes are warranted.
Utah Cardiac Recovery Program, Salt Lake City, Utah; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah.
Omar
O
Wever-Pinzon
Utah Cardiac Recovery Program, Salt Lake City, Utah; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah.
Stavros G
SG
Drakos
Utah Cardiac Recovery Program, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah; Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Stephen H
SH
McKellar
Intermountain Medical Center, Murray, Utah.
Benjamin D
BD
Horne
Utah Cardiac Recovery Program, Salt Lake City, Utah; Intermountain Medical Center, Murray, Utah.
William T
WT
Caine
Utah Cardiac Recovery Program, Salt Lake City, Utah; Intermountain Medical Center, Murray, Utah.
Abdallah G
AG
Kfoury
Utah Cardiac Recovery Program, Salt Lake City, Utah; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah.
Dean Y
DY
Li
Utah Cardiac Recovery Program, Salt Lake City, Utah; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah.
James C
JC
Fang
Utah Cardiac Recovery Program, Salt Lake City, Utah; Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah.
Josef
J
Stehlik
Utah Cardiac Recovery Program, Salt Lake City, Utah; Veterans Affairs Medical Center, Salt Lake City, Utah; Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: craig.selzman@hsc.utah.edu.
Craig H
CH
Selzman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
bridge; explantation; heart failure; unloading