(1070) - Blood Product Utilization in Continuous Flow Left Ventricular Assist Devices: Single Institution Trends

Abstract

Despite successful blood product (BPs) conservation in adult cardiac surgery, use of BPs remains high during Continuous Flow-Left Ventricular Assist Device (CF-LVAD) implantation. We examined trends in BPs utilization during implantation of CF-LVADS. We reviewed the institutional Society of Thoracic Surgery (STS) database at an academic LVAD program from 2007 - 2015. Identified cohorts were: Destination (DT) or Bridge to Transplant (BTT), Heartware (HW) or Heartmate II (HM II), era of implantation (first 87 consecutive patients vs second 88 consecutive patients), and patients that received BPs intra or post-operatively (RBPs) or BPs naïve patients (BPN). Risk factors for BPs use were compared using the t-test or chi-square. Multivariate analysis was done with Cox PH regression. 5 year Kaplan-Meier survival curves were created and the log rank test was employed to compare groups. 176 patients underwent CF-LVAD implantation from 2007-2015. Cohorts were heterogeneous in preoperative variables. Multivariate analysis identified DT, HM II, early era, pre-operative hematocrit, and redo-sternotomies as significant independent risk factors for BPs use. 44 Patients (25% of CF-LVAD implantations) were managed without use of BPs. Surgical re-exploration for bleeding was 8 %. BPN patients had improved 30 day mortality (RBP 16.03% vs BPN 2.27%, p=0.047) and shorter ICU lengths of stay (RBP 249+/-215 hrs vs BPN 182+/-76 hrs, p=0.049). 5 year Kaplan-Meier curve trended towards improved survival for BPN patients but lacked significance (p=0.06). Index hospitalization hemoglobin nadir for RBP patients was 7.06+/-1.10 verse a nadir of 7.74+/-1.0 for BPN patients (p=<0.01). BPs use declined at our institution over the CF-LVAD implantation experience. DT, HM II, early era patients, pre-op hematocrit and redo-sternotomies were risk factors for BPs use. CF-LVADs can be safely implanted without any use of BPs. BPN patients had shorter ICU lengths of stay, improved 30 day mortality and trended towards improved 5 year survival. Post operatively patients can be safely managed with a hemoglobin less than 8 with good outcomes.