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Lookup NU author(s): Dr Guy MacGowanORCiD,
Dr Gareth Parry,
Dr Stephan Schueler
This is the authors' accepted manuscript of an article that has been published in its final definitive form by Lippincott Williams and Wilkins, 2017.
For re-use rights please refer to the publisher's terms and conditions.
Copyright © 2017 by the American Society for Artificial Internal Organs To manage myocardial recovery in patients with the HeartWare left ventricular assist device (HVAD), we describe a minimally invasive approach (‘decommissioning’) that involves disconnecting the driveline and occluding the outflow tract through a small left thoracotomy incision leaving the device in situ, in conjunction with optimal medical therapies and comprehensive assessment of left ventricular recovery. Nine patients (all male, 37 ± 12 years, all non-ischemic dilated cardiomyopathy) had an HVAD implanted for 766±343 days. When left ventricular function improved to mild impairment by echocardiography, patients underwent assessment at reduced flow (2578±148 to 1822±67 rpm) with documentation of compensated right heart hemodynamics and ejection fraction 52±8%. Eight of nine patients underwent decommissioning, and 1 patient had a hybrid procedure of percutaneous occlusion of outflow graft and surgical division of driveline. 2 patients died post operatively at 413 days (sepsis) and 810 days (heart failure). In conclusion, in selected patients with non-ischemic dilated cardiomyopathy a prolonged period of HVAD support in conjunction with heart failure medications can lead to recovery of left ventricular function. Surgical decommissioning is then an option to remove these patients from support. These patients are however not ‘cured’ and remain at risk for future deterioration in ventricular function and infections.
Author(s): MacGowan GA, Wrightson N, Robinson-Smith N, Woods A, Parry G, Gould K, Schueler S
Publication type: Article
Publication status: Published
Journal: ASAIO Journal
Online publication date: 01/05/2017
Acceptance date: 02/04/2016
Date deposited: 04/05/2017
ISSN (print): 1058-2916
ISSN (electronic): 1538-943X
Publisher: Lippincott Williams and Wilkins
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