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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Is implantable cardioverter defibrillator surgery in patients with an implanted left ventricular assist device safe

Maximilian Vondran1,2, Konstantin von Aspern1, Jens Garbade1

  • 1University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.

Artificial Organs
|February 22, 2022
PubMed

Insights

Uninterrupted oral anticoagulation for patients with left ventricular assist devices (LVAD) undergoing implantable cardioverter-defibrillator (ICD) surgery is safe. This strategy significantly reduces hospital stay without increasing adverse events compared to heparin bridging.

Area of Science:

  • Cardiology
  • Medical Devices
  • Surgical Procedures

Background:

  • Implantable cardioverter-defibrillator (ICD) surgery in patients with left ventricular assist devices (LVAD) carries a high bleeding risk due to necessary anticoagulation.
  • Current practices often involve heparin bridging, which may increase complications.

Purpose of the Study:

  • To evaluate the safety and efficacy of uninterrupted oral anticoagulation versus heparin bridging during ICD surgery in LVAD patients.
  • To compare bleeding complications, re-exploratory surgery rates, and hospital length of stay between the two anticoagulation strategies.

Main Methods:

  • A retrospective study of 116 LVAD patients undergoing ICD surgery between January 2009 and January 2020.
  • Patients were divided into two groups: continued oral anticoagulation with a vitamin K antagonist (VKA group, n=60) and heparin bridging (heparin group, n=56).
  • Demographics, perioperative data, complications, and mortality were analyzed.

Main Results:

  • The heparin group showed a trend towards more bleeding complications (19.6% vs. 10.0%) and re-exploratory surgeries (14.3% vs. 5.0%), though not statistically significant.
  • Patients in the heparin group had a significantly longer postoperative hospital stay (17.8 days vs. 8.3 days, p=0.007).
  • No procedure-related deaths, thromboembolic events, or LVAD thrombosis were observed in either group.

Conclusions:

  • Uninterrupted oral anticoagulation is a safe strategy for LVAD patients undergoing ICD surgery.
  • This approach more than halves the number of hospital days without an increase in adverse events.
  • The findings support a shift towards uninterrupted anticoagulation in this high-risk patient population.
Abstract

Keywords:
cardiac resynchronization therapycardiac surgeryhigh riskimplantable cardioverter-defibrillatororal anticoagulationventricular assist device

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