Impact of Time Course of LVAD-Mediated Reverse Remodeling on Post Explantation Long-Term Sustainability of Favorable Clinical Response: Insights from RESTAGE-HF

Purpose The RESTAGE-HF multicenter study demonstrated high rates of myocardial recovery after combining LVAD support with HF pharmacological therapy and regular cardiac function monitoring protocol. We sought to investigate whether the time course of LVAD-mediated reverse remodeling impacts the post-explantation long-term sustainability of myocardial recovery. Methods We studied 36 HeartMate II LVAD patients with advanced non-ischemic dilated cardiomyopathy who completed the study protocol. LVAD explantations occurred when patients met the reverse remodeling criteria with the LVADs turned-down to minimum speed: LVEF >45%, left ventricular end diastolic diameter (LVEDD) 2.4 L/min/m2. We investigated whether meeting these criteria 12 months post-LVAD support impacted long-term sustainability of the myocardial structural and functional response or long-term survival free of Transplant (Tx) or LVAD. Results Nineteen patients (53%) met criteria and underwent LVAD explantation. Patients explanted at 12 months post-LVAD were 2 (10.5%), 9 (47.4%) and 8 (42.1%), respectively. There were no significant differences (p=0.80) in the survival free of Tx or LVAD at 1, 3, and 5 years post-LVAD removal between patients explanted at Conclusion In RESTAGE-HF multicenter study the time course of reverse remodeling during LVAD support did not appear to impact the long-term sustainability of the post-explantation favorable clinical response either in terms of long-term survival free of HF recurrence or stability of the improved cardiac structure and function.