Remission From Stage D Heart Failure

The encouraging results from the LVAD based recovery series suggest that the significant
hemodynamic unloading provided by the Mechanical Circulatory Support (MCS) in conjunction
with aggressive pharmacological treatment may induce a profound reverse structural
remodeling and in turn result in a curative alternative to a specific patient population
with severe heart failure. The active identification and characterization of the patients
with a high potential for full cardiac function recovery is of paramount importance. The
development of a standard and simplified recovery protocol would ultimately lead to a larger
bridge to recovery patient population. The primary objective of this study is to determine
the proportion of subjects who have sufficient improvement in ventricular function
(remission from heart failure) after undergoing a standardized LVAD plus pharmacologic
recovery treatment and testing protocol to allow removal of the LVAD within 18 months. The
secondary objectives of this study are twofold, first to determine the durability of
sustained remission from HF following LVAD explantation at 12 months and up to 3 years and
second to determine the predictors of recovery.

Inclusion Criteria:

1. Subject age between 18 - 59 years, inclusive

2. Subject indicated for DT or BTT

3. Subject with severe clinical heart failure resistant to intensive medical therapy and
requiring LVAD implantation

4. Subject with LVEF < 25% and cardiomegaly at the time of LVAD implantation as
documented by radionuclide or contrast ventriculography or by echocardiography

5. Subject with non-ischemic etiology (confirmed by angiography either within 2 years of
implantation or prior to explantation)

6. Subject have undergone HM II implantation within prior 4 weeks or planned for a HM II
implant

7. Subject has a history of HF < 5 years.

Exclusion Criteria:

1. Subject has evidence of active acute myocarditis confirmed by histology

2. Subject has a history of previous CVA resulting in significant fixed motor deficit
limiting ability to perform exercise testing

3. Subject has been implanted with a mechanical aortic and/or mitral valve(s)

4. Subject had an aortic valve closure

5. Subject diagnosed with a hypertrophic obstructive cardiomyopathy or sarcoidosis

6. Subject with LVEDD below normal confirmed by surface echocardiogram (restrictive
cardiomyopathy)

7. Subject has irreversible multi-organ failure

8. Pregnant or lactating women or unwilling to utilize two reliable methods of birth
control for women of childbearing age

9. Subject is diagnosed with a psychiatric disease, irreversible cognitive dysfunction
or poor psychosocial issues that is likely to impair compliance with the study
protocol

10. Subject with any condition, other than heart failure, that could limit survival to
less than 2 years

11. Subject has a history of cardiac or other organ transplant

12. Subject is contraindicated to anticoagulation antiplatelet therapy

13. Subject requires acute or chronic renal replacement therapy (e.g. chronic dialysis)
within 3 months prior to enrollment

14. Subject participating in any other clinical investigations involving another
Mechanical Circulatory Support (MCS) device or heart failure related drug, or
investigations which are likely to confound study results or affect study outcome.