Why the study?
Guideline-directed parameters to identify LVAD weaning candidates are lacking and long-term outcomes after weaning remain imperfectly documented.
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.
Answers are grounded in this paper and cite their sources.
May flag LVAD weaning candidates via early remodeling; leaves open need for prospective validation before practice change.
ABSTRACT Background 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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Lalancette et al. (2025) studied this question.
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