Concomitant Cardiac Procedures during Implantation of Long-Term Continuous-Flow LVADs: A European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Analysis

Abstract

There are still discordant data on the effect of concomitant cardiac procedures (CCPs) performed during left ventricular assist device (LVAD) implantation. By investigating on the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) dataset, we identified 2760 patients (pts) who underwent continuous-flow (CF) long-term LVAD implantation. LVAD implantation was associated with a single CCP in 533 pts (19.3%). A propensity score (PS) matching (LVAD pts, n=481 vs. LVAD+CCP pts, n=481) analysis has been perfomed. Intensive care unit (ICU) stay (20.9 vs. 25.5 days, p=0.019) and major bleeding requiring rethoracotomy (4.1% vs. 7.2%, p=0.027) resulted to be more frequent in LVAD+CPP cohort. Hospital mortality (17.4% vs. 22.2%, p=0.063) resulted to be comparable. Only coronary artery bypass grafting (p=0.041, OR 2.03, CI 1.03-4.02) did impact negatively. Extremes of body mass index (BMI), preoperative poor haemodynamics, dependance on inotropes infusion and extracorporeal life support (ECLS) resulted to be risk factors, after adjustment for baseline characteristics. During the mid- to long-term postoperative period, LVAD+CCP population showed higher incidence of bleeding (6.9% vs. 10.8%, p=0.031) and infectious adverse events (9.6% vs. 15.4%, p=0.022), respectively. Follow-up mortality (22.5% vs. 20.3%, p=0.432) resulted to be comparable. Valve surgery concomitant with LVAD implant seemed not to be associated with poor clinical outcomes (p=0.785). Mitral valve repair resulted to be protective in the long-term period (p=0.041), while tricuspid valve repair did not have any influence (p=0.108). No differences were observed by Kaplan-Meier survival analysis in the two cohorts (log-rank p=0.81, PS matched). In summary, performance of CCPs may not increase peri-operative mortality and type of concomitant surgery addressed should be properly weighted. Mid- to long-term survival is not influenced by CCPs. This, however, remains a delicate population to be strictly monitored and homogeneously managed to preserve satisfactory outcomes.