Publication Date
6-10-2021
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-20-7266
PMID
34111275
Publication Date(s)
June 2021
Language
English
PMCID
PMC8262831
PubMedCentral® Posted Date
6-10-2021
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Device removal, heart failure/physiopathology/therapy, heart-assist devices, recovery of function/physiology, severity of illness index, time factors, treatment outcome, ventricular dysfunction, left/therapy
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Continuous-flow left ventricular assist devices have proved to be effective, durable, life-saving tools in patients with end-stage heart failure. However, because of the risks associated with mechanical circulatory support (including stroke, infection, gastrointestinal bleeding, and device malfunction), the optimal goal of device therapy is myocardial recovery and device removal. Ventricular reconditioning and pump explantation after continuous-flow support have been reported; however, little is known about variables that govern the pace and degree of myocardial response in patients who experience such recovery. We describe our long-term pump-weaning strategy for a 25-year-old man who had a continuous-flow device implanted and then needed more than 5 years of support from it before developing cardiac reserve sufficient to enable pump explantation. To our knowledge, this is the longest period of uninterrupted continuous-flow device support to end in successful pump deactivation and a return to medical therapy. This case highlights the importance of actively and persistently pursuing a device-weaning strategy in all patients who need left ventricular assist device therapy.