Surgical approach to continuous-flow left ventricular assist device explantation: A comparison of outcomes

J Thorac Cardiovasc Surg. 2016 Jan;151(1):192-8. doi: 10.1016/j.jtcvs.2015.08.024. Epub 2015 Aug 13.


Objective: Ventricular reconditioning and device weaning in select patients with continuous-flow left ventricular assist devices (CF LVADs) has been shown to be feasible. However, little is known regarding the outcomes associated with different surgical methods of device removal. We examined the effect of surgical explantation approach on early and late outcomes.

Methods: We retrospectively reviewed data from all patients who underwent successful ventricular weaning and CF LVAD explantation at our center. Patients were stratified by surgical approach. Descriptive univariate statistics, multivariate regression, and survival analyses were performed. Patients were censored by transplant, device reimplantation, or end of follow-up.

Results: Twenty-seven patients were identified who underwent successful removal of a CF LVAD (25 HeartMate II, 2 HeartWare) after 532 ± 424 days of support (range, 42-1937 days). Four approaches were used that vary primarily in the degree of retained pump material: complete pump removal with plug ventriculotomy closure (n = 13; 48%), pump housing explant with ligation of the inflow and outflow grafts (n = 7; 26%), ligation of the outflow graft and driveline transection (n = 5; 19%), and driveline transection alone (n = 2; 7%). Mean overall postexplant survival was 1286 ± 947 days (range, 143-3072 days). Overall time-to-event and survival analyses showed no significant association between surgical approach and postoperative length of stay (P = .7), stroke (P = .12), reoperation (P = .4), or survival (P = .12).

Conclusions: For patients who receive device therapy, pump deactivation and removal represents a favorable outcome. All methods are feasible and produce similar early and late survival and clinical outcomes.

Keywords: device explantation; left ventricular assist device (LVAD); ventricular reconditioning; ventricular recovery.

MeSH terms

  • Adult
  • Device Removal / adverse effects
  • Device Removal / methods*
  • Device Removal / mortality
  • Feasibility Studies
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Kaplan-Meier Estimate
  • Length of Stay
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Prosthesis Design
  • Recovery of Function
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Texas
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left*
  • Young Adult