Abstract 4146711: A meta-analysis of myocardial recovery and its associated factors in advanced heart failure with left ventricular assist device

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Introduction: Patients with advanced heart failure use left ventricular assist devices (LVAD) to improve their outcomes and enhance the reverse remodeling of the heart. There has been no previous meta-analysis on the percentage or predictors of myocardial recovery after LVAD according to the device strategy. This study aims to find the pooled percentage and determinants of myocardial recovery after LVAD. Methods: A systematic search was done in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to April 2024. We used relevant keywords to include the studies that reported the percentage of people who have achieved myocardial recovery after LVAD. The percentage of participants using LVAD and achieved myocardial recovery was extracted and pooled results were stratified according to the device strategy. RevMan 5.4 was used for the meta-analysis. Results: We included 30 studies comprising 38708 patients with various LVADs used among the participants. Across the studies, multiple terms for myocardial recovery were used, most commonly being device explant following myocardial recovery and achieving left ventricular ejection fraction (LVEF) ≥40% after using LVAD. The overall pooled percentage of people who achieved myocardial recovery was 4.61% (95% CI [3.77, 5.45]), and the result was heterogeneous (I2 = 93%, p <0.00001). The percentage of myocardial recovery in patients implanted as a bridge to recovery (BTR) was 24.8%, 11.1% for a bridge to transplant (BTT) and 2.9% for mixed device strategy (Figure 1). Shorter duration of heart failure, female gender, younger age, absence of implantable cardioverter-defibrillator (ICD), and low left ventricular end-diastolic diameter (LVEDD) were the most cited factors associated with myocardial recovery. Conclusion: Myocardial recovery following LVAD is low and was found to be high in patients implanted for BTR. Several factors have been identified as potential predictors of myocardial recovery in patients on LVAD therapy. Further action should be taken to improve the recovery among this population.

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