Predictive model of the sustainability of favorable response after LVAD weaning: a VAD wean registry analysis

Background/Introduction During left ventricular assist device (LVAD) support, a subset of heart failure (HF) patients can experience myocardial structural and functional improvement that can lead to device weaning. Purpose This study aimed to identify factors predicting a durable favorable response after weaning from LVAD support. Methods We studied 445 HF patients enrolled in the international multicenter VAD Wean Registry who received a durable continuous-flow LVAD from 2002 to 2023 and underwent device support weaning (Figure 1). Indications for LVAD weaning included: (a) structural and functional myocardial improvement meeting institutional criteria for "myocardial recovery" (i.e. responders) or (b) LVAD-related complications accompanied by variable degrees of cardiac improvement (i.e. partial responders). We obtained clinical data before and during LVAD support as well as after LVAD weaning. The primary outcome was 10-year freedom from death, transplant or LVAD re-implantation. Bootstrap imputation and LASSO variable selection techniques were used to derive a predictive model which was then internally validated. Results Patients were predominantly male (63.8%), with an average age of 42.6±14 years, and most of them had non-ischemic cardiomyopathy (89.6%). At 10-years, the estimated probability of event-free survival (without the need for transplant or LVAD re-implantation) was 52%. Out of 36 variables, we identified six that were included in a multivariate model achieving a C-statistic of 0.72 (95% CI: 0.66-0.78), (Table): age at LVAD implant, indication for LVAD weaning, RV dysfunction prior to LVAD weaning, beta blocker therapy at LVAD weaning, presence of implantable cardioverter-defibrillator (ICD), and extracorporeal membrane oxygenation prior to LVAD implant. Conclusions Using routine clinical data, we developed a tool to predict the durability of favorable response for 10 years after LVAD weaning. This model provides clinically useful prognostic information and could aid the management of LVAD patients.