Outcomes after implantable left ventricular assist device replacement procedures.

Published

Journal Article

As the duration of support increases for patients with continuous flow left ventricular assist devices (LVADs), device replacement may still be necessary for a variety of indications. Outcomes after replacement LVAD surgeries have not been extensively described, and whether these patients experience outcomes similar to primary LVAD implant patients remains unclear. From 2003 to 2012, 342 consecutive implantable LVAD procedures took place at a single institution, of which 201 were considered destination therapy. Within this larger group, 30 patients underwent 35 replacement procedures. The three major indications for replacement LVAD procedures were mechanical/electrical failure (57%), hemolysis/thrombosis (29%), and infection (14%). Propensity matching using preoperative characteristics was used to generate a primary implant control group to determine the impact of the replacement status on outcomes. Thirty-day and 1-year survival after LVAD replacement was 90% and 48%, respectively. Survival outcomes were worse for patients undergoing device replacement compared with the matched primary cohort (p = 0.03). The need for transfusion and the incidence of postoperative right ventricular and renal dysfunction were similar between the two groups, as was length of hospitalization. There was no difference between the rates of postoperative infection or stroke. Emergent replacement procedures had a higher mortality than those done nonemergently. Given these findings, earlier timing for replacement, temporary stabilization with an extracorporeal device, and use of a nonsternotomy surgical approach should be investigated as strategies to improve outcomes.

Full Text

Duke Authors

Cited Authors

  • Schechter, MA; Daneshmand, MA; Patel, CB; Blue, LJ; Rogers, JG; Milano, CA

Published Date

  • January 2014

Published In

Volume / Issue

  • 60 / 1

Start / End Page

  • 44 - 48

PubMed ID

  • 24270234

Pubmed Central ID

  • 24270234

Electronic International Standard Serial Number (EISSN)

  • 1538-943X

Digital Object Identifier (DOI)

  • 10.1097/MAT.0000000000000011

Language

  • eng

Conference Location

  • United States