Explantation of durable ventricular assist device for myocardial functional recovery in children: A report from the ACTION registry.

BACKGROUND

Ventricular assist device (VAD) explantation following myocardial functional recovery (MFR) remains rare in both adults and children. We aim to study the characteristics and outcomes of durable VAD explantation following MFR in children from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry.

METHODS

All explants of durable VAD, defined as intracorporeal continuous flow devices (ICF) and paracorporeal pulsatile flow devices (PPF), performed between March 2012 and August 2023 were identified within ACTION. Temporary devices were excluded. The primary outcome was VAD and heart transplant-free survival following explantation.

RESULTS

A total of 31 out of 938 patients (3.3%) underwent durable VAD explantation following MFR after a median VAD support duration of 111 days (IQR 59-183). The median age was 1.17 years (IQR 0.32-10.1), and weight was 8.4 kg (IQR 6-23.8). The underlying diagnosis was dilated cardiomyopathy/myocarditis in 64% (20/31) and congenital heart disease in 10% (3/31); others (8/31) accounted for 26%. Following VAD explantation, 10% (3/29) underwent reimplantation of VAD, 14% (4/29) underwent heart transplantation, and 3.4% (1/29) died following explantation. At the last follow-up, 72% (21/29) are alive without reimplantation of a VAD or heart transplantation at a median duration post-explant of 2 years.

CONCLUSIONS

Myocardial functional recovery resulting in VAD explantation remains a rare occurrence in children. However, the majority of children did not require advanced heart failure therapies after durable VAD explant, suggesting appropriate selection of candidates. Strategies to identify patients who may benefit from explantation and predictors of myocardial functional recovery after VAD are warranted.