LVAD-Explantation in Pediatric Heart Failure: Systematic Weaning Approach as a Safe Bridge to Recovery

All articles of this category (opens in new window) Background: Mechanical support with assist devices has become an established rescue option for pediatric patients with severe heart failure. A paracorporeal pulsatile left ventricular assist device (LVAD) is available for small children. It serves as a bridge to heart transplantation or a bridge to recovery. Weaning protocols vary between institutions worldwide. We would like to present our experience on VAD therapy in infants and children, including the establishment of a standardized weaning protocol. Methods: Between 2008 and 2025, a total of 77 VADs were implanted at our institution. Out of those 20/77 (25%) patients underwent a weaning evaluation from LVAD. This resulted in 17/77 patients (22%) with successful explantation and 1 patient with failure and LVAD reimplantation. Diagnosis of these 20 patients was described as: 10 (50%) myocarditis, 8 (40%) CMP, 1 (5%) CHD, 1 (5%) other. Patient mean age was 11.5 months (IQR: 3 months–5 years) Results: Time on VAD ranged between 2 and 7 months. In 2020, we developed a detailed weaning protocol including consecutive measurements of biomarkers, cardiogenetics, and serial transthoracic 4D-echocardiography. In addition, we performed detailed hemodynamics and 4D-TTE measurements in the cath lab during a prolonged BH pump stop of 30 to 45 minutes. Myocardial histology was performed at implantation and at least once again prior to weaning and explantation. The majority of patients met the criteria in accordance with our previously defined protocol and underwent successful LVAD explantation. All of these patients were discharged home after a mean of 13 days and remained in stable condition during follow-up of 5 to 16 months. Two of 11 patients missed the defined weaning thresholds and remained on LVAD. In summary, our weaning protocol predicted successful VAD explantation in eight out of nine patients (89%). Conclusion: Weaning from LVAD support after myocardial recovery was successful in 22% of our total VAD cohort with a diagnosis of myocarditis or cardiomyopathy. Systematic preexplant assessment using our standardized weaning protocol predicted successful and sustainable LVAD explantation with a predictive rate of 89% and a median follow-up of 11 months. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany