LVAD explantation in patients with cardiac recovery demonstrated a pooled perioperative mortality of 9.2% and 10-year survival of 65.7%, with continuous-flow devices showing lower HF recurrence.
Systematic Review (n=213)
Does LVAD explantation provide acceptable long-term survival and cardiac function in patients exhibiting cardiac recovery?
Explantation of LVADs in carefully selected patients with cardiac recovery yields encouraging 10-year survival and safety outcomes, with continuous-flow devices showing superior results compared to pulsatile devices.
Several studies have reported that a portion of patients who exhibit cardiac recovery during left ventricular assist device (LVAD) support can have their device explanted with reasonable long-term survival. The aim of this systematic review is to assess the survival and cardiac function in patients with explanted LVADs from the current literature. Electronic search was performed to identify all studies in English literature assessing LVAD explantation. All identified articles were systematically assessed using the inclusion and exclusion criteria. Selected studies were subjected to quantitative assessment. From 5 electronic databases, 11 studies (213 patients) were included. Pooled mean perioperative mortality rate of those explanted was 9.2% (95% CI, 5.0-14.5%; I = 0). Pooled mean late mortality rate was 15% (95% CI, 9.0-22.1%; I = 31%). The pooled 1, 5, and 10 year survival postexplant was 91, 76, and 65.7%, respectively. Pooled postweaning freedom from heart failure (HF) recurrence reached 81.3%. Subset analysis demonstrated that patients explanted from a continuous-flow LVAD versus pulsatile LVAD had a lower rate of HF recurrence (6.6 vs. 28.3%, p = 0.03) and LVAD reimplantation (7.5 vs. 37%, p = 0.001). Before LVAD explantation, overall mean left ventricular ejection fraction (LVEF) was 49%. Weighted pooled early and late postexplantation mean LVEF was 47.3 and 41.2%, respectively. Late postexplantation LVEF was significantly higher in the continuous-flow versus pulsatile LVAD subgroup (41.5 vs. 24%, p = 0.001). This review shows encouraging safety and 10 year survival outcomes after explantation of LVADs in carefully selected patients, with rates better than expected after a heart transplant. Recovery of the native heart is the most desirable clinical outcome in patients supported with LVADs and should be actively sought.
Phan et al. (2016) conducted a systematic review in Left ventricular assist device (LVAD) support with cardiac recovery (n=213). LVAD explantation vs. Pulsatile LVAD (in subset analysis) was evaluated on Perioperative mortality rate (95% CI 5.0-14.5). LVAD explantation in patients with cardiac recovery demonstrated a pooled perioperative mortality of 9.2% and 10-year survival of 65.7%, with continuous-flow devices showing lower HF recurrence.