Long-Term Outcomes Following Left Ventricular Assist Device (LVAD)-Deactivation Due to Myocardial Recovery: A Single-Center Retrospective Analysis

All articles of this category (opens in new window) Background: In a small subset of patients (1–2%) supported with a left ventricular assist device (LVAD), sufficient myocardial recovery may occur due to mechanical unloading of the left ventricle and intensified medical therapy, allowing LVAD deactivation. Deactivation strategies may range from minimally invasive driveline decommissioning to complete device explantation. Due to low incidence, heterogeneous weaning protocols, and limited long-term data, evidence in this area remains scarce. Methods: We conducted a retrospective single-center analysis of patients who underwent LVAD implantation between August 2007 and July 2024, and later achieved myocardial recovery sufficient for LVAD deactivation. Follow-up was 5 years. Primary endpoints included long-term left ventricular ejection fraction (LVEF), heart failure relapses, LVAD reimplantation, heart transplant, and all-cause mortality. Secondary endpoints were infections and thromboembolic events. Results: A total of 310 LVAD patients were screened, of which 10 (HeartMate II, n = 6 and HeartMate 3, n = 4) achieved successful LVAD deactivation after a median support duration of 690.5 days, IQR: 570.5 to 946.25 days (1.89 years, IQR: 1.56–2.59 years). Mean age was 54.2 years (IQR: 49.25–59 years), with 80% male. INTERMACS profiles at implantation were 40% INTERMACS 1 and 60% INTERMACS 3 to 4. The median LVEF was 20% (IQR: 15.5–24%) at device implantation and > 35% at deactivation. A full device explantation was performed in 30% (one HeartMate II and two HeartMate 3), and 70% underwent a minimal invasive decommissioning (five HeartMate II and two HeartMate 3). Patients received vitamin K antagonists for 3 months postexplantation and lifelong after decommissioning. LVEF remained preserved up to 1 year postdeactivation in most patients. Relapse of heart failure occurred in two explanted patients; no relapses were observed in the decommissioned group. No patients required LVAD reimplantation or transplant. Survival was 100% at 30 days and 1 year, and 80% at 5 years (two male HeartMate II patients died after decommissioning). Two other patients developed abdominal wall fistulation after decommissioning. No thromboembolic events were reported. Conclusion: Myocardial recovery permitting LVAD deactivation is rare but feasible, with favorable long-term outcomes. These findings contribute to the limited evidence and underscore the need for standardized weaning protocols, surgical techniques, and structured long-term follow-up. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany