Ventricular assist device–promoted recovery and technical aspects of explant

Feature Editor Note-Promoting left ventricular recovery after durable left ventricular assist device (LVAD) implantation remains a Holy Grail. Currently, less than 2% of patients exhibit signs of recovery after LVAD implantation, and even fewer tolerate device explantation without recurrence of heart failure. In this issue of the Journal, Drs Faerber and Doenst describe what we can do clinically to promote recovery, including how guidelinedirected medical therapy may facilitate structural remodeling of the unloaded heart. Identifying recovery in the presence of ventricular unloading also presents a challenge, and the authors describe weaning protocols for various devices. Current evidence suggests that there are clinical predictors of recovery, including younger age, nonischemic etiology, smaller left ventricular size, and shorter duration from diagnosis of heart failure, and these can be used to help draw our focus toward patients who are more likely to tolerate device weaning and explantation. In those patients, preparing for device explantation requires early surgical planning, often at the time of LVAD implantation, including correction of valvular lesions that will be hemodynamically significant in the absence of LVAD support.