Objectives: Left ventricular assist device (LVAD) treatment may lead to reverse remodeling in heart failure patients and functional cardiac recovery.  The ultimate goal after mechanical circulatory support allows explantation of the left ventricular assist device (LVAD). Here, we present our experience with VAD explantation after cardiac recovery including industry and off-label surgical strategies for pump removal.
Methods: We retrospectively analysed 320 LVAD implantations performed in our institution between 01/2009 and 12/2018. Exclusion criteria were pediatric VAD, use of BiVAD, and unplanned pump removal due to thrombosis. Eligibility for pump explantation was evaluated following hemodynamic ECHO and cardiac CT measurements. Baseline characteristics and clinical course of explanted VAD patients were collected preVAD, on pump and during follow up after pump removal.
Results: 11 VAD patients could be successfully weaned from LVAD support (3.4%) and underwent surgery for pump explantation. The devices used for circulatory support included pulsatile Berlin Heart Excor and newer generation continuous flow Incor, Heartware, HeartMate 3. All 11 patients survived perioperative period resulting in a 100% 30 day survival. 1 recovery patient died within the first year due to non cardiac reason and another after 684 days, respectively. Only 1 cardiac recovery patient  deteriorated and finally died 7 years after explantation.  Mean follow-up time of survived patients averages 5.2 years. At latest follow-up 91.7% of BTR patients had a return to an absolute LVEF to greater than 40%.
Conclusion: The removal of VAD after cardiac recovery is feasible and can safely be performed using different surgical strategies including redo sternotomy and lateral thoracotomy. Strictly following weaning protocols from VAD therapy individualized strategies need to be explained to the patients including off label plugs for newer generation Heartware and HeartMate 3.