Implementing a Programmatic Approach to Identify and Promote Ventricular Recovery in Pediatric Patients Supported With Ventricular Assist Devices

BACKGROUND: In October 2022, our center implemented a standardized program to promote ventricular recovery in pediatric patients supported with durable ventricular assist devices. We report our experience and outcomes. METHODS: The initiative consists of 4 core components for all patients with ventricular assist devices: (1) cultural shift: routine assessment for ventricular recovery for possible device explant or, in complex congenital heart disease (CHD), for further surgical palliation; (2) reverse remodeling-use of goal-directed medical therapy as tolerated; (3) assessment of recovery: stepwise evaluation by echocardiography, exercise testing, and cardiac catheterization; and (4) multidisciplinary review of patients. This retrospective cohort study includes all patients who underwent durable ventricular assist device implantation between October 2022 and October 2024. Patient characteristics and outcomes are described for those explanted for recovery. RESULTS: The cohort included 35 patients, 22 (63%) with Berlin Heart EXCOR and 13 (37%) with HeartMate 3. Indications included cardiomyopathy (60%, n=21), CHD (31%, n=11), coronary pathology (6%, n=2), and myocarditis (3%, n=1). Nine patients underwent explant (26% of all patients, 38% of patients without CHD). No patients with CHD met criteria for recovery. Median age of explanted patients was 1 year (interquartile range, 3 months-10 years), and all were discharged postexplant. Median follow-up was 10 months (interquartile range, 5.5-20 months). One patient was relisted for transplant; the others remained outpatient with, at worst, mild ventricular dysfunction. CONCLUSIONS: A standardized approach to ventricular recovery was associated with explant in 26% of patients, exclusively among those without CHD. Short-term postexplant outcomes are encouraging, supporting further study in larger cohorts.