A comparison between intraperitoneal and extraperitoneal left ventricular assist system placement

The HeartMate left ventricular assist system (LVAS) is being used with increasing frequency as a bridge to heart transplantation and for long-term support of chronic heart failure patients who are not transplant candidates. The surgical techniques and anatomic placement of the HeartMate are factors in minimizing complications that occur during long-term use. Device related bleeding, infection, and other intraabdominal complications are serious adverse events associated with the position of the LVAS. Clinical data from 48 HeartMate supported patients were analyzed retrospectively to determine differences in serious complication rates between intraperitoneal (IP) and extraperitoneal (EP) LVAS placement. The LVAS was placed IP in 37 patients (77%) and EP in 11 patients (23%). The occurrence of postoperative bleeding that required reoperation was 57% in the IP group and 64% in the EP group. Device related bleeding was 8% in the IP group and 29% in the EP. Neither difference in bleeding rate was statistically significant. The overall infection rate during the entire period of LVAS support was similar between groups (IP, 45.7%; EP, 46.2%; p = 0.25); however, device related infection occurred more often in the EP group (46%; IP, 14%; p = 0.025). All patients who recovered from LVAS implantation experienced mild early satiety, but were otherwise free of intra-abdominal complications. The transplantation rate was 64% for the IP group and 78% for the EP group. IP LVAS placement may offer additional protection against device related infections.