A102-14 Novel Explantation Protocol for Cardiac Recovery and Device Weaning Post Left Ventricular Assist Device Therapy: A Single Center Experience

Abstract While some patients, estimated over 10%, may exhibit significant myocardial improvement after the placement of a durable Left Ventricular Assist Device (LVAD), LVAD explantation is rare - comprising only 1% to 2% of patients in the Interagency Registry for Mechanically Assisted Circulatory Support registry. This discrepancy is in large part due to the lack of widely accepted guidelines on determining patients who may be eligible for explantation. In this single-center case series, three patients were evaluated for LVAD explantation 8 to 24 months after implantation using a rigorous multimodality protocol along with multidisciplinary team discussions to assess appropriateness for explantation. Patient 1 was a 39 year old male with cardiomyopathy secondary to alcohol use; patient 2 was a 31 year old male with cardiomyopathy secondary to methamphetamine use, and patient 3 was a 53 year old male who later had genetic testing performed that revealed a pathogenic desmoplakin mutation consistent with arrhythmogenic cardiomyopathy. Additional patient characteristics are described in Table 1. Similar to other groups who have developed single-center explantation protocols, we used a combination of non-invasive and invasive assessments to evaluate appropriateness for explantation; in addition, we monitored for real-time changes in hemodynamics via right heart catheterization during exercise, allowing us to evaluate for adequate cardiac function with stress. While Patients 1 and 2 have successfully remained device-free, Patient 3 ultimately underwent heart transplantation 2 months post-explantation and expired over a year after transplant from an out-of-hospital cardiac arrest, with autopsy revealing severe cardiac allograft vasculopathy secondary to post-transplant lymphoproliferative disorder. The two patients who underwent successful explantation were young males who had an acute presentation of cardiogenic shock, with the etiology of heart failure attributed to nonischemic cardiomyopathy secondary to substance use. Additionally, they regained cardiac function and functional capacity on durable LVAD support within one year. In contrast, Patient 3 was older, required LVAD support for longer duration, remained NYHA class II with LVEF 35-40% while on the device, and was ultimately found to have an underlying genetic cardiomyopathy. These differences elucidate potential predictors of success after LVAD explantation. We propose evaluating this protocol more broadly in patients with durable LVADs who demonstrate improved left ventricular function with the goal of ultimately developing standardized guidelines to assess appropriateness for LVAD explantation. This abstract is funded by: None