Transcatheter left ventricular assist device decommissioning

Abstract

Left ventricular assist devices (LVADs) provide mechanical circulatory support for patients with end-stage heart failure. In some patients, mechanical support may lead to adequate recovery of myocardial function. In such cases, discontinuation of LVAD support, known as decommissioning, may be appropriate. Traditionally, LVAD decommissioning required surgical explantation, a procedure associated with significant risk and surgical complexity. More recently, a less invasive approach has emerged utilizing transcatheter outflow graft occlusion and driveline transection. Here, we present seven cases of transcatheter LVAD decommissioning highlighting the procedure and potential clinical benefits.

Learning objective

Left ventricular assist device (LVAD) decommissioning with transcatheter outflow graft occlusion is a potential management option for patients exhibiting myocardial recovery and may be preferable to surgical explantation in carefully selected patients. More studies are needed to assess long-term outcomes after transcatheter LVAD decommissioning and define optimal anticoagulation management post-procedure.