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

Publication ,  Journal Article
Black-Maier, E; Lewis, RK; Loungani, R; Rehorn, M; Friedman, DJ; Bishawi, M; Schroder, JN; Milano, CA; Katz, JN; Patel, CB; Rogers, JG ...
Published in: JACC Clin Electrophysiol
September 2020

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.

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Published In

JACC Clin Electrophysiol

DOI

EISSN

2405-5018

Publication Date

September 2020

Volume

6

Issue

9

Start / End Page

1131 / 1139

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Humans
  • Heart-Assist Devices
  • Electronics
  • Defibrillators, Implantable
  • Arrhythmias, Cardiac
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Black-Maier, E., Lewis, R. K., Loungani, R., Rehorn, M., Friedman, D. J., Bishawi, M., … Piccini, J. P. (2020). Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation. JACC Clin Electrophysiol, 6(9), 1131–1139. https://doi.org/10.1016/j.jacep.2020.04.030
Black-Maier, Eric, Robert K. Lewis, Rahul Loungani, Michael Rehorn, Daniel J. Friedman, Muath Bishawi, Jacob N. Schroder, et al. “Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.JACC Clin Electrophysiol 6, no. 9 (September 2020): 1131–39. https://doi.org/10.1016/j.jacep.2020.04.030.
Black-Maier E, Lewis RK, Loungani R, Rehorn M, Friedman DJ, Bishawi M, et al. Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation. JACC Clin Electrophysiol. 2020 Sep;6(9):1131–9.
Black-Maier, Eric, et al. “Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.JACC Clin Electrophysiol, vol. 6, no. 9, Sept. 2020, pp. 1131–39. Pubmed, doi:10.1016/j.jacep.2020.04.030.
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. Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation. JACC Clin Electrophysiol. 2020 Sep;6(9):1131–1139.
Journal cover image

Published In

JACC Clin Electrophysiol

DOI

EISSN

2405-5018

Publication Date

September 2020

Volume

6

Issue

9

Start / End Page

1131 / 1139

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Humans
  • Heart-Assist Devices
  • Electronics
  • Defibrillators, Implantable
  • Arrhythmias, Cardiac
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology