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Left Ventricular Assist Device Decommissioning Compared with Explantation for Ventricular Recovery

A Systematic Review

Choi, Jae Hwan*; Weber, Matthew P.*; Horan, Dylan P.*; Luc, Jessica G. Y.; Phan, Kevin; Patel, Sinal*; Rizvi, Syed-Saif Abbas*; Maynes, Elizabeth J.*; Reeves, Gordon R.§; Entwistle, John W.*; Morris, Rohinton J.*; Massey, H. Todd*; Tchantchaleishvili, Vakhtang*

doi: 10.1097/MAT.0000000000000926
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Left ventricular assist device (LVAD) withdrawal with ventricular recovery represents the optimal outcome for patients previously implanted with an LVAD. The aim of this systematic review was to examine the patient outcomes of device withdrawal via minimally invasive pump decommissioning as compared with reoperation for pump explantation. An electronic search was performed to identify all studies in the English literature assessing LVAD withdrawal. All identified articles were systematically assessed for inclusion and exclusion criteria. Overall, 44 studies (85 patients) were included in the analysis, of whom 20% underwent decommissioning and 80% underwent explantation. The most commonly used LVAD types included the HeartMate II (decommissioning 23.5% vs. explantation 60.3%; p = 0.01) and HeartWare HVAD (decommissioning 76.5% vs. explantation 17.6%; p < 0.001). At median follow-up of 389 days, there were no significant differences in the incidence of cerebrovascular accidents (p = 0.88), infection (p = 0.75), and survival (p = 0.20). However, there was a trend toward a higher recurrence of heart failure in patients who underwent decommissioning as compared with explantation (decommissioning 15.4% vs. explantation 8.2%, cumulative hazard; p = 0.06). Decommissioning appears to be a feasible alternative to LVAD explantation in terms of overall patient outcomes.

From the *Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania

Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada

Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia

§Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania.

Submitted for consideration July 2018; accepted for publication in revised form September 2018.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Vakhtang Tchantchaleishvili, Division of Cardiothoracic Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107. Email: vakhtang.tchantchaleishvili@jefferson.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs