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Updated: Jan 19, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Effect of cardiac arrest with aortic cross-clamping during left ventricular assist device implantation
Masashi Kawabori1,2, Chitaru Kurihara1,2,3, Andre Critsinelis1,2
1Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Insights
Cardiac arrest during continuous-flow left ventricular assist device (CF-LVAD) implantation with aortic cross-clamping (AXC) did not worsen long-term survival or increase complications. This finding supports considering AXC when necessary for concomitant procedures during CF-LVAD surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Continuous-flow left ventricular assist devices (CF-LVADs) are crucial for end-stage heart failure.
- Concomitant procedures during CF-LVAD implantation may require cardiac arrest under aortic cross-clamping (AXC).
- The impact of cardiac arrest on right heart function in advanced heart failure patients is not well understood.
Purpose of the Study:
- To evaluate the association between cardiac arrest with AXC and patient outcomes during CF-LVAD implantation.
- To determine if AXC during CF-LVAD surgery negatively impacts survival or postoperative complications.
Main Methods:
- Retrospective analysis of 526 patients undergoing primary CF-LVAD implantation from November 2003 to March 2016.
- Comparison of outcomes between patients requiring cardiac arrest with AXC (n=50) and those not requiring AXC (n=476).
- Analysis included preoperative demographics, postoperative complications, and mortality rates.
Main Results:
- The most common AXC procedure was aortic valve closure.
- While AXC patients had longer cardiopulmonary bypass times, 5-year survival rates were similar between groups.
- Postoperative right heart failure and neurological dysfunction rates did not significantly differ between the AXC and non-AXC groups.
Conclusions:
- Cardiac arrest with AXC during CF-LVAD implantation does not adversely affect long-term survival.
- The incidence of right ventricular failure and stroke is not significantly increased by AXC during CF-LVAD implantation.
- Findings suggest AXC can be considered in surgical strategies for CF-LVAD patients when necessary.
Objectives:
Some patients who undergo continuous-flow left ventricular assist device (CF-LVAD) implantation require concomitant procedures that can be performed with or without cardiac arrest under aortic cross-clamping (AXC). Procedures normally performed with cardiac arrest are sometimes avoided or performed without cardiac arrest because it may be detrimental to right heart function. However, the effects of cardiac arrest on patients with advanced heart failure necessitating CF-LVAD support have not been thoroughly studied. We examined our single-centre experience to determine whether cardiac arrest during CF-LVAD implantation was associated with worse patient outcomes.
Methods:
From November 2003 to March 2016, a total of 526 patients with chronic end-stage heart failure underwent primary CF-LVAD implantation. Preoperative demographics, postoperative complications and mortality rates were compared between patients who required cardiac arrest with AXC (n = 50) and those who did not (n = 476).
Results:
The most frequently performed procedure requiring AXC was aortic valve closure (n = 23, 26.1%). Although the AXC group had longer cardiopulmonary bypass times (P < 0.01), long-term (5-year) survival was similar in AXC and non-AXC patients (P = 0.13). Also, postoperative right heart failure (P = 0.15) and neurological dysfunction (P = 0.89) rates were not significantly different between the 2 groups. Cox proportional hazards analysis showed that cardiac arrest with AXC was not an independent predictor of mortality (hazard ratio, 0.89; P = 0.73).
Conclusions:
Cardiac arrest with AXC during CF-LVAD implantation did not negatively affect long-term survival or the incidence of right ventricular failure or stroke. These findings should be considered in deciding surgical strategies. Additional investigation may be warranted to further understand the effects of cardiac arrest during LVAD implantation.
