Interventional Outflow Graft Closure in Patients successfully weaned from LVAD

J. Jozwiak-Nozdrzykowska (Leipzig)¹, K. Jawad (Leipzig)², M. Nozdrzykowski (Leipzig)², K. Kirsch (Leipzig)¹, M. A. Köhle (Leipzig)¹, C. Correia (Leipzig)², U. Schulz (Leipzig)², S. Eifert (Leipzig)², H. Gunold (Leipzig)¹, D. Sulimov (Leipzig)¹, I. Dähnert (Leipzig)³, D. Saeed (Leipzig)², M. A. Borger (Leipzig)², H. Thiele (Leipzig)¹, A. Dashkevich (Leipzig)⁴, M. Sandri (Leipzig)^1
1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; ²Herzzentrum Leipzig - Universität Leipzig Universitätsklinik für Herzchirurgie Leipzig, Deutschland; ³Herzzentrum Leipzig - Universität Leipzig Klinik für Kinderkardiologie Leipzig, Deutschland; ⁴Herzzentrum Leipzig Herzchirurgie Leipzig, Deutschland

Background: Left ventricular assist devices (LVAD) have become an important treatment option for advanced heart failure in recent years. The number of patients who achieve recovery of myocardial function under LVAD therapy is also increasing. Alternative methods to complete surgical device explantation are not sufficiently described

Methods and Results: Between January 2015 and October 2023, 455 consecutive patients, underwent LVAD implantation at our institution. The incidence of recovery of myocardial function under LVAD (def. as LV-EF ≥ 45%) was 4,8% (n=22). Patients unsuitable for surgical explantation underwent interventional outflow graft closure (n=13). Median time between LVAD implantation and intervention was 485 days (range 211-1661 days). The majority of patients presented with dilated cardiomyopathy (n=12) and only one with ischemic heart disease. Median age at the time of interventional closure was 60,3 years and 9 patients (69%) were male.  The implanted VADs were HVAD in 5 patients (38% patients) and HeartMate3 in 8 (61,5% patients). At the time of LVAD closure the LV-EF was 50% and all patients reported symptoms classifiable as NYHA I-(II). Implantation of percutaneous closure devices was performed via femoral access in all patients. For most patients Amplatzer™ Vascular Plug II (n= 10) was utilized, the remaining patients were treated using Amplatzer VSD occluder (n= 3). The procedure was successful in all patients. No adverse events related to the procedure were detected. Following closure, the VAD driveline was truncated below the skin level under local anesthesia. Complete closure of the outflow graft was achieved in 14 patients (100 %).

Conclusions: Interventional outflow graft closure in patients with improved left ventricular ejection fraction under LVAD support is a safe and effective alternative to redo surgery.