Left Ventricular Functional Improvement is Associated With Lower Morbidity and Mortality During Long-Term Mechanical Circulatory Support: An STS Intermacs Analysis

Background A subset of patients with advanced heart failure (HF) supported with durable left ventricular assist devices (LVADs) demonstrate significant improvement in left ventricular ejection fraction (LVEF), but the impact of such functional improvement on clinical outcomes is unclear.Methods We analyzed adults in the STS-Intermacs registry who underwent continuous-flow LVAD implantation (2006-2017) and had echocardiographic data ≥6 months post-implant. Post-LVAD myocardial function was defined by the maximum LVEF after ≥6 months of support and categorized as Results Among 9,518 eligible patients (age 56.6±13.2 years, 21.4% female), 1,131 (12%) achieved LVEF ≥40% over a median 27.0 months of follow-up. Compared with LVEF Conclusions In a large multicenter LVAD cohort, LV functional response to durable support spanned a spectrum, with ∼1 in 8 (12%) durable LVAD recipients achieving a maximum post-implant LVEF ≥40% after ≥6 months of support. Higher post-implant LVEF was independently associated with improved survival and fewer HF-related events. These findings support viewing myocardial improvement during LVAD support as a clinically meaningful target that affects positively the outcomes of patients while being on mechanical support.