Outcomes of Explanted LVAD Patients with Heart Failure Relapse Requiring Heart Replacement Therapies: A VAD Wean Registry Analysis

Purpose: Despite outstanding long-term survival in LVAD patients explanted for myocardial recovery, a subset will have heart failure (HF) relapse requiring heart replacement therapies (HRTs). We evaluated the incidence and long-term outcomes of HRTs among patients undergoing LVAD explant. Methods: VAD WEAN is an international, multicenter retrospective registry including patients undergoing LVAD explant. We evaluated the 1-year and 10-year incidence of HRTs (re-LVAD implant and heart transplantation [HT]) following LVAD weaning. The primary outcome was all-cause mortality following HRTs. Kaplan Meier (KM) curves were used to evaluate the incidence of the primary outcome. Follow-up was censored at last available follow-up. Results: 491 patients (female gender 34.8%, mean age 43 years, ischemic cardiomyopathy 12.1%, INTERMACS ≤3 86.7%) underwent LVAD explant after a median of 1.2 (interquartile range [IQR] 0.7-2.2) years from implant, of whom 84.7% for myocardial recovery. Of these, 361 (73.4%) were alive at a median of 4.4 (IQR 1.4-8.0) years after explant. KM estimate for 10-year survival was 62.6%. 63 (12.8%) patients required HRTs (n=31 [6.3%] re-LVAD implant, n=37 [7.5%] HT) after a median of 1.1 (IQR 0.4-4.4) years after LVAD explant. KM estimates for HRTs were 6.8% at 1 year and 20.8% at 10 years. Among patients undergoing re-LVAD implant, estimated 1-year survival was 66.6% and 10-year survival 15.8%. Among patients undergoing HT, estimated 1-year survival was 79.3% and 10-year survival 71.0%. Conclusion: The long-term survival of HF patients weaned from LVAD support appears similar to contemporary post-HT survival with only one in five patients experiencing HF relapse requiring HRTs at 10 years. In these patients with HF relapse the outcomes of HRTs were favorable.