title: Myocardial Recovery Strategy with Decommissioning for the HeartWare Left Ventricular Assist Device.
abstract: To manage myocardial recovery in patients with the HeartWare left ventricular assist device (HVAD), we describe a minimally invasive approach (decommissioning) that involves disconnecting the driveline and occluding the outflow tract through a small left thoracotomy incision, leaving the device in situ, in conjunction with optimal medical therapies and comprehensive assessment of left ventricular recovery. Nine patients (all male, 37 ± 12 years, all nonischemic dilated cardiomyopathy) had an HVAD implanted for 766 ± 343 days. When left ventricular function improved to mild impairment by echocardiography, patients underwent assessment at reduced flow (2578 ± 148 to 1822 ± 67 rpm) with documentation of compensated right heart hemodynamics and ejection fraction 52 ± 8%. Eight of nine patients underwent decommissioning, and 1 patient had a hybrid procedure of percutaneous occlusion of outflow graft and surgical division of driveline. Two patients died postoperatively at 413 days (sepsis) and 810 days (heart failure). In conclusion, in selected patients with nonischemic dilated cardiomyopathy, a prolonged period of HVAD support in conjunction with heart failure medications can lead to recovery of left ventricular function. Surgical decommissioning is then an option to remove these patients from support. These patients are, however, not cured and remain at risk for future deterioration in ventricular function and infections.
authors.affiliation: From the *Department of Cardiology Freeman Hospital and †Institute of Genetic Medicine, Newcastle University, United Kingdom; and ‡Department of Cardiothoracic Surgery and §Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Guy A
authors.initials: GA
authors.lastname: MacGowan
authors.forename: Neil
authors.initials: N
authors.lastname: Wrightson
authors.forename: Nicola
authors.initials: N
authors.lastname: Robinson-Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Woods
authors.forename: Gareth
authors.initials: G
authors.lastname: Parry
authors.forename: Kate
authors.initials: K
authors.lastname: Gould
authors.forename: Stephan
authors.initials: S
authors.lastname: Schueler
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016277:Ventricular Function, Left