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

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support
• Heart Failure Management

Background:

• Guidelines for concomitant procedures (CPs) during continuous flow-left ventricular assist device (CF-LVAD) implantation are not well-defined.
• The impact of increased surgical complexity from CPs on CF-LVAD outcomes is largely unreported.

Purpose of the Study:

• To analyze the impact of CPs on survival and device-related complications in CF-LVAD recipients.
• To identify predictors of mortality and adverse device events in patients undergoing CF-LVAD implantation with or without CPs.

Main Methods:

• Retrospective analysis of 614 patients who underwent CF-LVAD implantation between May 2004 and December 2013.
• Patients were stratified based on whether they underwent concomitant procedures (n=216) or not (n=398).
• Survival and device-related complications were analyzed and compared between groups.

Main Results:

• Survival rates were comparable between patients with and without CPs, irrespective of device type or indication.
• Patients undergoing CPs experienced a shorter time to the first device-related adverse event.
• Increased age, baseline creatinine, cardiopulmonary bypass time, and decreased BMI predicted mortality.
• Age and prior sternotomy were associated with adverse device-related events.

Conclusions:

• Concomitant procedures can be performed during CF-LVAD implantation with comparable survival and device-related outcomes.
• The decision to perform CPs should consider patient factors like age, renal function, and surgical complexity.