Experience with a standardized protocol to predict successful explantation of left ventricular assist devices

Hrytsyna, Y.; Kneissler, Simon; Kaufmann, Friedrich; Müller, Marcus; Schoenrath, Felix; Mulzer, Johanna; Sündermann, Simon H.; Falk, Volkmar; Potapov, Evgenij; Knierim, Jan

doi:10.1016/j.jtcvs.2021.01.001

Cited by 16 publications

(26 citation statements)

References 22 publications

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“…In line with current literature on durable MCS, our current data indicates that right heart failure and the necessity for temporary MCS trigger adverse outcome [7][8][9]. Many efforts have been made to identify predictors for peri-and postoperative right heart failure [7][8][9], but it remains an open question because no parameter has been identified to improve outcome in LVAD right heart failure so far and cardiac index decline during follow-up in our study population may particularly represent right heart failure [10,11]. No predictor for right heart failure is available in LVAD patients, neither for worsening of preexisting right heart failure, not for postprocedural right heart failure development [12].…”

Section: Discussionsupporting

confidence: 88%

Safety, Mortality, and Hemodynamic Impact of Patients with MitraClip Undergoing Left Ventricular Assist Device Implantation

Fox

Gyoten

Rojas

et al. 2021

J. of Cardiovasc. Trans. Res.

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The interactions and hemodynamic impact of transcatheter percutaneous mitral valve repair (TMR) have not yet been investigated in patients undergoing left ventricular assist device (LVAD) implantation, but hemodynamic adverse effects are feared in the combination of TMR and LVAD for altered mitral valve flow. This study investigated the hemodynamic interplay in combination of TMR and LVAD in 119 patients, and propensity score match analysis revealed no difference in both perioperative mortality and 2-year follow-up survival (p = 0.84). Nonetheless, postoperatively mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac index improved, and multivariable cox regression analysis at 2 years identified preoperative total bilirubin and temporary right ventricular mechanical circulatory support as independent risk factors for all-cause mortality but not TMR. Prior TMR has no impact on mortality or cardiovascular complications in patients with LVAD. Graphical abstract

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Section: Discussionsupporting

confidence: 88%

Safety, Mortality, and Hemodynamic Impact of Patients with MitraClip Undergoing Left Ventricular Assist Device Implantation

Fox

Gyoten

Rojas

et al. 2021

J. of Cardiovasc. Trans. Res.

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“…An increasing number of anecdotal success cases of LVAD weaning and explantation have been reported lately [ 1 , 12–15 ]. The incidence of myocardial recovery and subsequent LVAD explantation in young patients with dilative cardiomyopathy or acute myocarditis and with shorter durations of heart failure is increasing, with a rate of 5–10% [ 5 , 7 ] and up to 50% in strictly selected patients with optimal heart failure medication [ 1 ]. Large prospective studies to facilitate myocardial recovery during LVAD support are currently underway.…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial recovery may allow weaning and subsequent LVAD explantation [ 4 ]. Reported explantation rates from different centres vary from >50% in prospective trials on selected patients to 3.9% in a single centre [ 5 ] and 1.2% to 1.3% in large registries [ 6 ]. The number of patients undergoing LVAD implantation at an earlier stage of heart failure and the growing knowledge about mechanical support could increase the number of patients with the potential for myocardial recovery and subsequent LVAD explantation.…”

Section: Introductionmentioning

confidence: 99%

Results from a multicentre evaluation of plug use for left ventricular assist device explantation

Potapov

Politis

Kretzler

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Myocardial recovery allows for left ventricular assist device (LVAD) explantations after long-term support. Several surgical approaches, including interventional decommissioning, off-pump explantation using a custom-made plug and complete LVAD removal through redo sternotomy, have been described. We present the results from an evaluation of the long-term follow-up of patients who received a titanium sintered plug after LVAD explantation. METHODS We performed a retrospective, European, multicentre analysis of patients who received a titanium sintered plug to seal the apical fixation ring after LVAD explantation. Data were collected from a questionnaire that included demographics, procedural details and follow-up information. RESULTS Out of 54 contacted centres in 12 countries (n = 179 patients), a total of 68 patients were successfully included in the study. The median follow-up was 34 months (interquartile range: 17–58.5 months); 57 (84%) patients had >1-year follow-up. At the time of the last follow-up, 55 (81%) patients were alive, with a Kaplan–Meier 1-year survival of 90.1% (95% confidence interval: 84.0–98.1%) and a 5-year survival of 80.0% (95% confidence interval: 68.4–92.9%). One patient (1.5%) developed a plug infection originating from an infected part of the incorporated driveline and, after complete removal, is currently in good condition. No postoperative stroke has been reported after plug implantation. CONCLUSIONS In this European multicentre study, the use of a custom-made titanium plug to close the apical fixation ring after LVAD explantation resulted in a low incidence of plug-related complications. With the volume of patients undergoing LVAD explantations after myocardial recovery increasing, the plug has evolved as a simple alternative to more invasive device explantation procedures or decommissioning with a high risk for infection of the remaining system or stroke.

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“…In their article in the Journal, Dr Hrytsyna and colleagues report their experience with a protocolized method of assessing myocardial recovery with the aim of aggressive left ventricular assist device (LVAD) explantation. 1 This single-institution retrospective review has 2 helpful characteristics: a large LVAD population (544 patients) and a long-standing protocol-based assessment for explantation, initiated in 2016. After 4 years of using this protocol, 57 patients (10%) met the authors' screening criteria and underwent speed manipulation under echocardiographic guidance (including pump stoppage).…”

mentioning

confidence: 99%

Commentary: The debate continues on optimal myocardial recovery assessment

Hawkins

Yarboro

Mehaffey

2022

The Journal of Thoracic and Cardiovascular Surgery

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Experience with a standardized protocol to predict successful explantation of left ventricular assist devices

Cited by 16 publications

References 22 publications

Safety, Mortality, and Hemodynamic Impact of Patients with MitraClip Undergoing Left Ventricular Assist Device Implantation

Safety, Mortality, and Hemodynamic Impact of Patients with MitraClip Undergoing Left Ventricular Assist Device Implantation

Results from a multicentre evaluation of plug use for left ventricular assist device explantation

Commentary: The debate continues on optimal myocardial recovery assessment

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