Left Ventricular Assist Device Decommissioning Compared with Explantation for Ventricular Recovery: A Systematic Review.

Authors

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

Publication/Presentation Date

1-1-2020

Abstract

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.

Volume

66

Issue

1

First Page

17

Last Page

22

ISSN

1538-943X

Published In/Presented At

Choi, J. H., Weber, M. P., Horan, D. P., Luc, J. G. Y., Phan, K., Patel, S., Rizvi, S. A., Maynes, E. J., Reeves, G. R., Entwistle, J. W., Morris, R. J., Massey, H. T., & Tchantchaleishvili, V. (2020). Left Ventricular Assist Device Decommissioning Compared with Explantation for Ventricular Recovery: A Systematic Review. ASAIO journal (American Society for Artificial Internal Organs : 1992), 66(1), 17–22. https://doi.org/10.1097/MAT.0000000000000926

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

30489294

Department(s)

Administration and Leadership

Document Type

Article