Myocardial recovery evaluation from ventricular assist device in patients with dilated cardiomyopathy

Aims The removal of left ventricular assist device (LVAD) after myocardial recovery can provide survival benefits with freedom from LVAD‐associated complications. However, in the absence of standardization, the weaning evaluation and surgical strategy differ widely among centres. Therefore, we analysed the experiences of LVAD explantation with our protocol in dilated cardiomyopathy (DCM) patients and investigated the validity of our weaning evaluation and surgical strategy from the perspective of optimal long‐term survival. Methods and results All LVAD explantation patients in our institution between May 2012 and May 2020 were enrolled. All patients were evaluated by our three‐phase weaning assessment: (i) clinical stability with improved cardiac function under LVAD support; (ii) haemodynamic stability shown by ramp‐loading and saline‐loading test; (iii) intraoperative pump‐off test. Explant surgery involved removal of the whole system including driveline, pump, sewing ring and outflow‐graft, and closure of an apical hole. Intra‐operative, peri‐operative, and post‐operative outcomes, including all‐cause mortality and LVAD associated major complications, were retrospectively analysed. A total of 12 DCM patients (DuraHeart, n = 2; EVAHEART, n = 2; HeartMate II, n = 6; HeartMate 3, n = 2) had myocardial recovery after a median 10 months [interquartile range (IQR); 6.3–15 months] support and qualified for our LVAD explantation study protocol [median age: 37 y, IQR; 34–41 years; 83% men]. The median left ventricular ejection fraction was 20% (IQR; 12–23%) at LVAD‐implantation and 54% (IQR: 45–55%) before LVAD explantation (P