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Left ventricular assist device exchange: the Toronto General Hospital experience.
Hideki Tsubota1, Roberto V P Ribeiro1, Filio Billia1
1From the Advanced Heart Failure Program, Ted Rogers Centre for Heart Research and the Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.
Summary
Left ventricular assist device (LVAD) exchanges are uncommon but necessary. Pump thrombosis is the main reason for LVAD replacement, which can be done safely.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Procedures
Background:
- Increasing support times for left ventricular assist devices (LVADs) lead to complications requiring device exchange.
- This study reports the first Canadian experience with implantable LVAD exchange.
Purpose of the Study:
- To analyze the incidence, indications, and outcomes of LVAD exchange procedures.
- To evaluate the safety and efficacy of LVAD exchange in a Canadian center.
Main Methods:
- Retrospective review of consecutive patients implanted with LVADs from June 2006 to October 2015.
- Analysis of patient demographics, device types, reasons for exchange, surgical approaches, and patient outcomes.
Main Results:
- Nine of 122 patients (7.3%) required LVAD exchange, with 7 HeartMate II (HMII), 1 HVAD, and 1 DuraHeart device exchanged.
- Pump thrombosis was the most frequent indication for exchange (6 cases), followed by driveline fracture and inflow obstruction.
- The subcostal approach was successfully used in 4 cases for HMII exchange.
Conclusions:
- LVAD exchange, primarily due to pump thrombosis, can be performed with acceptable morbidity and mortality.
- The subcostal approach may be a preferred method for HeartMate II exchanges when indicated.
