• Yoan Lamarche, Mark Kearns, Kiranbir Josan, Jamil Bashir, Andrew Ignaszewski, Annemarie Kaan, Jennifer Kealy, Robert Moss, and Anson Cheung.
• Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada. yoanlamarche@gmail.com
• Can J Cardiol. 2011 May 1;27(3):358-62.

BackgroundVentricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre.MethodsPatients who had a VAD explanted were identified in the mechanical support institutional database and their outcomes were analyzed. Clinical examinations, biochemical markers, and serial echocardiograms were used to demonstrate myocardial recovery.ResultsSeventeen patients had a Heartmate II VAD inserted between 2008 and 2010. Four patients underwent successful weaning and subsequent VAD explantation. Etiology of decompensated heart failure was idiopathic dilated cardiomyopathy (n = 1), ischemic (n = 1), or myocarditis (n = 2). Mean age was 35.3 years. Patients were supported for 213 days (range 70-293 days) and were in New York Heart Association class I in the community before explantation. The devices were explanted via a minimally invasive approach, without cardiopulmonary bypass. All patients survived explantation and were discharged alive from hospital after an average of 5.7 ± 1.5 days post pump explantation. No adverse events were reported after explantation. Only one patient required allogenic blood transfusion after the procedure.ConclusionsPatients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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