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Implantable LVAD insertion in patients with previous heart surgery
1Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Ohio 44195, USA. mccartp@cesmtp.ccf.org
Summary
Adjusting left ventricular assist device (LVAD) implantation techniques can overcome challenges in patients with prior heart surgery. Modified approaches ensure successful LVAD support, improving outcomes for this complex patient group.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Cardiac Support
Background:
- Implantable left ventricular assist device (LVAD) insertion presents unique technical challenges in patients with prior cardiac operations.
- A significant proportion of LVAD recipients have a history of heart surgery, necessitating tailored implantation strategies.
Purpose of the Study:
- To evaluate the feasibility and outcomes of adapting standard LVAD implantation techniques for patients with previous cardiac surgery.
- To identify and address specific technical obstacles encountered during LVAD implantation in reoperative cardiac surgery patients.
Main Methods:
- Retrospective analysis of 135 LVAD patients, with 72 (53%) having undergone prior heart surgery.
- Specific modifications included management of coronary artery bypass grafts, altered apical cannulation for ventricular access, and replacement of mechanical valves.
- Strategies for implantable cardioverter defibrillators and device component placement were also adapted.
Main Results:
- No significant differences were observed in reoperation rates for bleeding between primary and reoperative groups (22% vs 23%).
- Perioperative right ventricular assist device (RVAD) support rates were comparable (12% vs 7%).
- Survival to heart transplantation showed no significant difference between the groups (82% vs 72%).
Conclusions:
- Standard LVAD implantation techniques can be successfully adjusted to manage the complexities associated with prior cardiac surgery.
- Modified LVAD implantation strategies are effective in overcoming technical obstacles and achieving favorable outcomes in reoperative patients.