Abstract Background
Ventricular assist device (VAD) explantation following myocardial functional recovery (MFR) remains rare in both adults and children. We aim to study the characteristics and outcomes of durable VAD explantation following MFR in children from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry.
Methods
All explants of durable VAD, defined as intracorporeal continuous flow devices (ICF) and paracorporeal pulsatile devices (PPF) performed between March 2012 to August 2023 were identified within ACTION. Temporary devices were excluded. The primary outcome was VAD and heart transplant-free survival following explantation.
Results
A total of 31 out of 938 patients (3.3%) underwent durable VAD explantation following MFR after a median VAD support duration of 111 days (IQR 59 – 183). The median age was 1.17 years (IQR 0.32 – 10.1) and weight was 8.4 kg (IQR 6 – 23.8). The underlying diagnosis was dilated cardiomyopathy/myocarditis in 64 % (20/31) and congenital heart disease in 10 % (3/31); others (8/31) accounted for 26%. Following VAD explantation, 10% (3/29) underwent reimplantation of VAD, 14% (4/29) underwent heart transplantation, and 3.4% (1/29) died following explantation. At last follow up, 72% (21/29) are alive without reimplantation of a VAD or heart transplantation at a median duration post-explant of 2 years.
Conclusions
Myocardial functional recovery resulting in VAD explantation remains a rare occurrence in children. However, the majority of children did not require advanced heart failure therapies after durable VAD explant, suggesting appropriate selection of candidates. Strategies to identify patients who may benefit from explantation and predictors of myocardial functional recovery after VAD are warranted.
This ACTION study was published online in The Journal of Heart and Lung Transplantation on June 15, 2026. Congratulations to the authors:
- Bhavikkumar Langanecha MD
- Aamir Jeewa MD
- Iki Adachi MD
- Constantine D. Mavroudis MD MSc MTR
- Muhammad Shezad MBBS MSd
- Mohammed Absi MD
- Othman Aljohani MBBS MPH
- Shahnawaz Amdani MD
- Scott Auerbach MD
- Ryan Butts MD
- Jonathan Byrnes MD
- Chesney Castleberry MD
- Jennifer Conway MD
- Jonathan B Edelson MD
- Anna Joong MD
- Sairah Khan MD
- Steven Kindel MD
- Sabrina Law MD
- Angela Lorts MD MBA
- Lindsay May MD
- Deipanjan Nandi MD
- John Jerry Parent MD
- Joseph Philip MD
- David Rosenthal MD
- David Sutcliffe MD
- Hari Tunuguntla MD MPH
- Christina VanderPluym MD
- Matthew Zinn DO
- Matthew J. O’Connor MD
- Kyle Hope MD MS
CITATION
Langanecha B, Jeewa A, et al. Explantation Of Durable Ventricular Assist Device For Myocardial Functional Recovery In Children: A Report From The ACTION Registry. The Journal of Heart and Lung Transplantation. 2026; 0. https://doi.org/10.1016/j.healun.2026.06.007.
