Outcomes After Concomitant Procedures with Left Ventricular Assist Device Implantation: Implications by Device Type and Indication

Abstract

Guidelines for performing concomitant procedures (CPs) in patients undergoing continuous flow-left ventricular assist device (CF-LVAD) implantation are unclear. The impact of an increased surgical complexity outside the constraint of landmark clinical trials has not been reported. From May 2004 to December 2013, 614 patients (499 males, 81%) underwent CF-LVAD implant at our institutions. Median age was 57 ± 13 years and 364 (59%) were bridge to transplantation (BTT). Survival and device-related complications were analyzed and stratified based on the surgical intervention. A total of 398 patients (65%) underwent CF-LVAD implantation without CPs. The remaining patients (35%, n = 216) were grouped according to various CPs. Survival was comparable between groups and not influenced by the CP, device type, or indication for implant. Time-to-first device-related adverse event was shorter in patients with CPs. Regression analysis revealed only increased age (p = 0.03), increase in baseline creatinine (p = 0.002), cardiopulmonary bypass time (p = 0.03), and decreased body mass index (p = 0.03) were predictors of mortality, whereas only age (p = 0.006) and prior sternotomy (p = 0.02) were related to adverse device-related events. Performing CPs leads to comparable survival and device-related outcomes after implant. The decision to perform CPs should be balanced with age, preoperative renal dysfunction, and projected complexity of surgery.

Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement

“…Morgan et al demonstrated that concomitant cardiac procedures like aortic or tricuspid valve surgery during LVAD implantation are not assumed with higher procedural risks [ 2 ]. Maltais et al reported about similar findings but emphasized the patient-to-patient-wise decision-making with focus on age, preoperative renal function, and the complexity of planned surgery [ 3 ].…”

Effect of novel bicaval anastomosis technique for transplantation with and without prior cardiac surgery history

“…However, donor heart sources are limited, and the donor heart should be given to those recipients with a relatively small risk to achieve maximum benefit (3). Whether a recipient for HTx with a prior cardiac surgery history is at greater risk than someone without prior cardiac surgery is still under discussion, and there is no clear consensus (4)(5)(6). Moreover, the widely used bicaval anastomosis method in HTx still has some postoperative complications such as left atrial thrombosis and anastomotic hemorrhage (7), which is why we propose a novel fourcorner traction bicaval anastomosis combined with a continuous everting suture technique.…”

Concomitant Cardiac Procedures during Implantation of Long-Term Continuous-Flow LVADs: A European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Analysis

“…Coexisting concomitant cardiac disease addressed surgically might complicate the placement and efficient functioning of left ventricular assist devices (LVADs) [1][2][3][4][5][6][7][8][9][10][11].…”