Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.

Journal Article (Journal Article)

OBJECTIVES: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. BACKGROUND: Many patients with a left ventricular assist device (LVAD) will require implantable cardioverter-defibrillator generator change or device revision or are candidates for de novo implantable cardioverter-defibrillator implantation following LVAD implantation. METHODS: We performed an observational retrospective study of all LVAD recipients who subsequently underwent CIED surgery at Duke University Hospital from 2009 to 2019. RESULTS: A total of 159 patients underwent CIED surgery following LVAD implantation, including generator change (n = 93), device revision (n = 38), and de novo implant (n = 28). The median (interquartile range) time from LVAD implantation to CIED surgery was 18.1 months (5.5 to 35.1 months). Pre-operative risk for infection was elevated in the overall cohort with a median (interquartile range) Prevention of Arrhythmia Device Infection Trial (PADIT) score of 7.0 (5.0 to 9.0). Pocket hematoma occurred in 21 patients (13.2%) following CIED surgery. Antimicrobial envelops were used in 43 patients (27%). Device infection due to CIED surgery occurred in 5 (3.1%) patients and occurred only in patients who developed post-operative pocket hematoma (p < 0.001). Mortality at 1 year following CIED surgery was 20% (n = 32). CONCLUSIONS: CIED surgery following LVAD implantation is associated with an increased risk for pocket hematoma and CIED infection. Further studies are needed to determine the risk-benefit ratio of CIED surgery in patients with LVADs.

Full Text

Duke Authors

Cited Authors

  • Black-Maier, E; Lewis, RK; Loungani, R; Rehorn, M; Friedman, DJ; Bishawi, M; Schroder, JN; Milano, CA; Katz, JN; Patel, CB; Rogers, JG; Hegland, DD; Jackson, KP; Frazier-Mills, C; Pokorney, SD; Daubert, JP; Piccini, JP

Published Date

  • September 2020

Published In

Volume / Issue

  • 6 / 9

Start / End Page

  • 1131 - 1139

PubMed ID

  • 32972548

Electronic International Standard Serial Number (EISSN)

  • 2405-5018

Digital Object Identifier (DOI)

  • 10.1016/j.jacep.2020.04.030

Language

  • eng

Conference Location

  • United States