What does this research mean for the field?

LVAD-induced myocardial recovery and successful device weaning occur in a significant proportion of patients, particularly those with toxic cardiomyopathies, and can be predicted by early improvements in LVEF and LVEDD at 3 months post-implantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 15, 2025Open Access

Myocardial Recovery After Left Ventricular Assist Device Weaning in Patients With Predominantly Toxic Cardiomyopathy: A Single-center Experience

JLJean‐Simon LalancetteMontreal Heart Institute ABAlexander Beaulieu‐ShearerInstitut Universitaire de Cardiologie et de Pneumologie de Québec ÉVÉmile VoisineInstitut Universitaire de Cardiologie et de Pneumologie de Québec

Structured PICO

Population

98 patients who underwent second or third generation left-ventricular assist device (LVAD) implantation between 2009-2021

Intervention

LVAD weaning after myocardial recovery

Comparator

Unweaned patients (continued LVAD support)

Outcome

Clinical and echocardiographic characteristics of weaned patients and event-free survival following weaning

Early reverse remodeling with improved LVEF and decreased LVEDD at 3 months post-LVAD implantation may identify candidates for successful LVAD weaning, particularly in those with toxic cardiomyopathy.

Abstract

ABSTRACTBackground In some patients with left-ventricular assist devices (LVADs), unloading of the left ventricle (LV) and medical therapy may lead to improvement of LV systolic function, allowing for LVAD weaning. There are no guideline-directed parameters to help identify candidates for weaning and long-term outcomes remain imperfectly documented. We aimed to assess the clinical and echocardiographic characteristics of weaned patients and to evaluate their event-free survival following weaning. Methods Single-center retrospective study recruiting all patients who underwent second or third generation LVAD implantation between 2009-2021. Results 98 patients were included. Fourteen patients (14%) with LV recovery underwent LVAD weaning after 309 days of median support time. Heart failure etiologies in weaned patients included toxic (recreational drugs) (n=8, 57%), toxic (medication) (n = 2, 14%), ischemic (n=2, 14%) and idiopathic dilated cardiomyopathy (n=2, 14%). In unweaned patients, heart failure was mostly attributed to ischemic (n=35, 42%) and idiopathic dilated (n=27, 32%) cardiomyopathy. Three months after implantation, patients who were eventually weaned had higher LVEF (35 vs. 19%, p=0.001) and lower left ventricular end diastolic diameter (LVEDD) (52 vs. 60 mm, p=0.03) than unweaned patients. At last follow-up after weaning, mean LVEF was 44±6% and no death nor heart transplant had occurred. Conclusion LVADs can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially those with toxic and non-ischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months following implantation may suggest potential candidacy for LVAD weaning. Weaned patients maintain satisfactory LVEF recovery after weaning and have good long-term event-free survival.

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