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Eur J Cardiothorac Surg 2004;26:730-735
© 2004 Elsevier Science NL

Clinical situations demanding weaning from long-term ventricular assist devices

^a Department of Thoracic and Cardiovascular Surgery, University Hospital Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany
^b Department of Internal Medicine C-Cardiology, University Hospital Münster, Münster, Germany
^c Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
^d Department of Anesthesia and Operative Intensive Care Medicine, University Hospital Münster, Münster, Germany

Received 17 May 2004; received in revised form 7 July 2004; accepted 8 July 2004.

^* Corresponding author. Tel.: +49-251-835-7412; fax: +49-251-834-8316. (E-mail: schmid{at}uni-muenster.de).

Objective: Ventricular assist devices are increasingly used to treat patients with acute or chronic end-stage heart failure. We report on circumstances, exemplified on four cases, where a surprisingly favorable clinical course of the patients ultimately demanded early explantation of the device, which was not anticipated prior to its implantation. Methods: The four patients were provided with implantable (Micromed BeBakey\#8482;, Incor\#8482;) and external pneumatically driven (Thoratec\#8482;, Excor\#8482;) devices under emergency conditions and were listed for heart transplantation. Results: All four patients had an unexpected recovery of myocardial pump function. After careful diagnostic evaluation, all device components were completely removed without extracorporeal circulation. No stepwise weaning protocol was employed. Conclusions: Weaning patients from ventricular assist devices after recovery of myocardial pump function can become necessary. Diagnostic evaluation and the implementation of a weaning protocol is still a matter of debate, while complete surgical removal of all device components without extracorporeal circulation is possible with a low risk.