Surgical Approaches to Left Ventricular Assist Device Deactivation: Lessons From Remission From Stage D Heart Failure

Background Remission From Stage D Heart Failure (RESTAGE-HF) was a multicenter study demonstrating that a selected patient population with left ventricular assist devices (LVADs) could achieve functional recovery and subsequent durable pump explantation. The purpose of our study was to describe the impact of surgical approach to deactivation in this study cohort. Methods The study prospectively enrolled 40 patients with HeartMate II LVAD. Overall, 19 (52.8%) of 36 evaluable patients reached the predefined criteria and underwent LVAD deactivation. Three approaches were used: complete explantation (n = 8), partial explantation (n = 10), and percutaneous decommissioning (n = 1). The primary outcome was survival free from transplantation or LVAD reimplantation. Results Patients with partial explantation had a longer duration of heart failure and a larger posterior wall thickness before ventricular assist device implantation. There were no differences in other preimplantation parameters. Median follow-up was 7.9 years. Median time to deactivation was similar between approaches. Post-LVAD survival free from LVAD reimplantation or transplantation was 90% at 1 year and remained stable after 4 years at 74% for the entire cohort. No significant intergroup differences in 7-year survival were observed (87.5% vs 40%; P = .06). Conclusions This analysis represents the longest follow-up of post-LVAD patients stratified by surgical approach and suggests that select patients can achieve sustained myocardial recovery after LVAD deactivation.