To Explant or Not to Explant: An Invasive and Noninvasive Monitoring Protocol to Determine the Need of Continued Ventricular Assist Device Support


Satoru Osaki, MD, PhD, Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, H4/337 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3236


Predictors of myocardial recovery after ventricular assist device (VAD) implantation are not well defined. The authors report their current VAD weaning protocol. Between 2003 and 2006, 38 patients received VAD implants. The authors performed 5 tests in 4 patients in whom echocardiography findings suggested myocardial recovery after implant. The protocol consists of assessing symptoms, electrocardiographic findings, hemodynamics, and cardiac function at baseline and as VAD support is weaned. As a result, 3 patients passed the weaning protocol and were explanted. There has been no recurrence of heart failure 667, 752, and 1007 days after explant, respectively. One patient failed the protocol after 151 days of support because of low cardiac index during the protocol. This patient was transplanted. This current experience of VAD weaning protocol is a novel tool to identify candidates for successful VAD explantation.