Outcomes of Repeat Left Ventricular Assist Device Exchange.

Area of Science:

• Cardiology
• Medical Devices
• Surgical Procedures

Background:

• Continuous-flow left ventricular assist devices (CF-LVADs) provide essential long-term support for advanced heart failure patients, serving as a bridge to transplantation or as destination therapy.
• Prolonged use of CF-LVADs can lead to recurrent complications, necessitating device replacement and raising questions about the safety and efficacy of repeat procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of repeat device exchange in patients requiring multiple continuous-flow left ventricular assist device implantations.
• To identify common indications for CF-LVAD exchange and assess patient outcomes, including survival and postoperative complications.

Main Methods:

• Retrospective review of data from 25 patients who underwent two or more CF-LVAD implantations between July 2005 and August 2017.
• Analysis of indications for device exchange, types of devices implanted, hospital length of stay, duration of support, survival rates, and postoperative complications.

Main Results:

• The primary indications for repeat CF-LVAD exchange were electromechanical device malfunction (56%), thrombus/hemolysis (32%), and infection (12%).
• Sixty-eight percent of patients survived to discharge, with an average support duration of 802 days post-exchange. Overall survival was 72% at 1 year and 60% at 2 years.
• Common postoperative complications included respiratory failure (20%), device infection (20%), bleeding requiring reoperation (16%), and neurologic dysfunction (16%).

Conclusions:

• Repeat CF-LVAD exchange is a viable and feasible strategy for managing recurrent device-related complications in select heart failure patients.
• Despite potential postoperative complications, repeat LVAD exchange can provide significant long-term hemodynamic support and improve survival rates.