Deactivation of LVAD support for myocardial recovery-surgical perspectives

Ian Nickel; Evgenij Potapov; Benjamin Sun; Daniel Zimpfer; Antigone Koliopoulou; Iki Adachi; Anelechi Anyanwu; Volkmar Falk; Pavan Atluri; Gloria Faerber; Daniel Goldstein; Leora Yarboro; Mark S Slaughter; Carmelo Milano; Masaki Tsukashita; David D'Alessandro; Scott Silvestry; Hristo Kirov; Swaroop Bommareddi; Pia Lanmüller; Torsten Doenst; Craig H Selzman

doi:10.1016/j.healun.2024.05.005

Deactivation of LVAD support for myocardial recovery-surgical perspectives

J Heart Lung Transplant. 2024 May 12:S1053-2498(24)01662-0. doi: 10.1016/j.healun.2024.05.005. Online ahead of print.

Authors

Ian Nickel¹, Evgenij Potapov², Benjamin Sun³, Daniel Zimpfer⁴, Antigone Koliopoulou⁵, Iki Adachi⁶, Anelechi Anyanwu⁷, Volkmar Falk⁸, Pavan Atluri⁹, Gloria Faerber¹⁰, Daniel Goldstein¹¹, Leora Yarboro¹², Mark S Slaughter¹³, Carmelo Milano¹⁴, Masaki Tsukashita¹⁵, David D'Alessandro¹⁶, Scott Silvestry¹⁷, Hristo Kirov¹⁰, Swaroop Bommareddi¹⁸, Pia Lanmüller², Torsten Doenst¹⁰, Craig H Selzman¹⁹

Affiliations

¹ Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
² Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
³ Division of Cardiothoracic Surgery, Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, Minnesota.
⁴ Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.
⁵ Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, Athens, Greece.
⁶ Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
⁷ Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
⁸ Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany; Department of Health Sciences and Technology, Translational Cardiovascular Technologies, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.
⁹ Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁰ Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Jena, Germany.
¹¹ Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
¹² Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
¹³ Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
¹⁴ Department of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina.
¹⁵ Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
¹⁶ Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
¹⁷ Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida.
¹⁸ Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee.
¹⁹ Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah. Electronic address: Craig.selzman@hsc.utah.edu.

PMID: 38744354
DOI: 10.1016/j.healun.2024.05.005

Abstract

Left ventricular assist devices (LVADs) are excellent therapies for advanced heart failure patients either bridged to transplant or for lifetime use. LVADs also allow for reverse remodeling of the failing heart that is often associated with functional improvement. Indeed, growing enthusiasm exists to better understand this population of patients, whereby the LVAD is used as an adjunct to mediate myocardial recovery. When patients achieve benchmarks suggesting that they no longer need LVAD support, questions related to the discontinuation of LVAD therapy become front and center. The purpose of this review is to provide a surgical perspective on the practical and technical issues surrounding LVAD deactivation.

Keywords: VAD; decommissioning; explant; heart failure; mechanical circulatory support; myocardial recovery.

Publication types

Review