Long-term Safety of Minimally Invasive Left Ventricular Assist Device Discontinuation for Myocardial Recovery.

BACKGROUND: Left ventricular assist devices (LVADs) play important roles in advanced heart failure (HF) management. In patients who experience myocardial recovery, the LVAD is often explanted via a resternotomy, which may negatively impact the newly recovered heart. We describe a case-series of LVAD discontinuation using a minimally invasive approach, focusing on thromboembolic phenomenon and infection rates in long-term follow-up. METHODS: Our study is a single-center, retrospective case series of patients with myocardial recovery after mechanical unloading with an LVAD. Patients underwent outflow graft ligation through a minimally invasive approach with driveline excision. Postdiscontinuation, patients obtained serial transthoracic echocardiograms for a minimum of 6 months and followed with our heart failure specialist. RESULTS: All 7 recovery patients had nonischemic cardiomyopathy and included 4 women (57%). Mean age was 44.3 ± 15.6 years. Median LVAD support duration was 454 (interquartile range, 326 to 1096) days. Intensive care unit length of stay and total length of stay were 3.4 ± 1.9 days and 6.3 ± 2.3 days, respectively. Blood transfusion rate was 0.86 ± 1.1 units. At a median follow-up of 874 (interquartile range, 864 to 1007) days, no patients developed thromboembolic phenomena despite use of aspirin only for prophylaxis. One patient experienced driveline infection, who had persistent driveline infection before procedure. CONCLUSIONS: This minimally invasive approach for LVAD discontinuation through outflow graft ligation, driveline removal, and LVAD stoppage in setting of myocardial recovery avoids resternotomy risks. Despite leaving the LVAD in situ, there was no risk of thromboembolism or infection associated with residual hardware.

Ambulatory Ventricular Assist Device Patient Management.

Understanding the ventricular assist device (VAD) patient pump interface and developing expertise in monitoring patients with a VAD are the goals of care in the ambulatory setting. The objective is to improve long-term outcomes. The purpose of expert, focused, routine outpatient surveillance is to facilitate the integration of pulseless, electrically dependent VAD patients into the community. Other goals of outpatient care include maximizing quality of life, maintaining equipment integrity, treating heart failure symptoms, monitoring for common VAD-related complications, ensuring viability as a heart transplant candidate, consideration for patients implanted to become transplantable, and monitoring for possible cardiac recovery.

Regionalized approach to emergency medical services training for the care of patients with mechanical assist devices.

Advances in mechanical circulatory assist device technology have allowed dozens of patients with different types of devices to live in any community in the United States. Some of the newer devices pump blood continuously, resulting in patients without pulses. The mechanical circulatory assist device teams and emergency medical services providers in the mid-Atlantic region wondered how best to prepare the community to respond appropriately to emergencies in patients with these mechanical devices.