Abstract 18819: Clinical Outcomes Following Implantation of a Centrifugal Flow Left-Ventricular Assist Device and Concomitant Cardiac Valve Procedures

Abstract

Purpose: Patients undergoing implantation of left ventricular assist devices (LVAD) often undergo concomitant cardiac valve procedures, but the added procedural risk has not been studied in detail. We reviewed patients receiving a centrifugal flow LVAD system in the ADVANCE Bridge to Transplant Trial (BTT) and Continued Access Protocol (CAP) to evaluate the impact of concomitant valve procedures on early outcomes. Methods: The ADVANCE BTT and CAP trial enrolled 381 patients (pts) through November 2012. This group was divided into two subgroups: pts who underwent a concomitant valve procedure in addition to LVAD implant (VP) and those who did not undergo a concomitant valve procedure (no VP). Preop characteristics, adverse events and Kaplan-Meier survival were compared for the two groups. Results: A total of 19.7% (75/381) of pts underwent VP at the time of LVAD implantation. The most frequent procedure was tricuspid valve repair or replacement, performed in 14.7% of pts, followed by aortic (3.4%), and mitral (2.1%) valve procedures. Patients undergoing a VP were younger and had more recent onset of heart failure. Other pre-implant variables were similar for the two groups. Length of time on cardiopulmonary bypass was increased for VP pts, but mean length of hospital stay did not differ. Proportions of pts having perioperative tamponade, bleeding, arrhythmias, or strokes were similar. VP pts had more right heart failure (RHF) requiring inotropic therapy (37.3% vs. 22.9%, P =0.01); however, there was no difference in RHF requiring RVAD support (2.7% vs. 2.6%, P =1.00). Overall Kaplan Meier survival for the two groups was similar, 97.3% VP vs. 98.0% No VP at 30 days and 88.2% VP vs. 90.5% No VP at 6 months ( P =0.57). Survival was also similar for aortic (N=13) versus tricuspid (N=56) procedures, with 6 month survival 90.0% and 88.5%, respectively ( P =0.75). Conclusion: Tricuspid repair was the most common VP. Increased post-op RHF may have reflected more pre-op right heart dysfunction in this patient subgroup. Overall, the concomitant valve group experienced very good survival, suggesting that VP can be performed at the time of LVAD implant with minimal additional risk.