Abstract 19302: Surgical Approach to Continuous Flow Left Ventricular Assist Device Explantation: a Comparison of Outcomes
Objective: Weaning and explanation of selected patients with continuous flow left ventricular assist devices (CF LVADs) has been shown to be feasible. Clinical outcomes are poorly described regarding the various operative approaches employed, which differ primarily in the degree of retained pump material. We evaluate the impact of CF LVAD explant surgical approach on early and late clinical events.
Methods: A single-center, retrospective review was performed, evaluating all patients who underwent explanation of a CF LVAD (2006-2014). Descriptive univariate statistics, multivariate regression and survival analysis were performed. Patients were stratified by surgical approach, and censored by transplant, device re-implantation or death.
Results: A total of 27 patients were identified (25 HeartMateII, 2 HeartWare); characteristics and outcomes are listed in Figure 1a. Four approaches were used: complete pump and outflow excision with ventriculotomy closure (n=13 ; 48%), pump excision and ligation of inflow and outflow grafts (n=7 ; 26%), ligation of outflow graft and driveline transection (n=5 ; 19%), or driveline transection alone (n=2 ; 7%). Primary incisions were subcostal (n=19, 70%) or subxiphoid (n=5, 19%), with 1 conversion to sternotomy (n=1, 7%). Mean duration of CF support prior to explant was 532±424 days (range 42-1937 days), while post-explant survival (defined as time preceding transplant, device re-implantation, or death) was 1116±927 days (range 127-2877 days). Survival stratified by surgical approach is shown in Figure 1b. Overall time-to-event and survival analyses showed no significant difference in postoperative length of stay (p=0.7), stroke (p=0.12), reoperation (p=0.4), or total survival (p=0.12) between surgical approaches.
Conclusions: This is the largest description of CF LVAD explantation by surgical approach. While technical difficulty varies, all are feasible with similar early and late survival and clinical outcomes.
- Artificial heart/Cardiac support devices
- Cardiac surgery
- Heart failure
- Transplantation/surgical aspects
Author Disclosures: A.C. Baldwin: None. S.K. Singh: None. E. Sandoval: None. J. Anand: None. W.E. Cohn: None. H.R. Mallidi: None. O. Frazier: None.
- © 2014 by American Heart Association, Inc.