Incidence, Factors and Prognostic Impact of Re-Exploration for Bleedings after Continuous Flow Left Ventricular Assist Device Implantation

Abstract

Continuous flow left ventricular device (CF-LVAD) brings a substantial survival improvement in end-staged heart failure patients. However, bleeding complications are common after CF-LVAD implantation, and in some cases a re-exploration for bleedings is needed. We investigated the incidence, timing and risk factors for a re-exploration for bleedings after CF-LVAD implantation. we retrospectively reviewed 162 consecutive patients (age 43 ± 13 years, 71% men) who underwent CF-LVAD implantation (HeartMateII 119, Jarvik2000 15, HVAD 13, EVAHEART 10, DuraHeart 5) in our center from January 2012 to June 2019. The baseline patient characteristics, peri-operative factors, post-operative platelet counts and post-operative antithrombotic therapy were retrospectively collected from the electronic medical record. During the follow up period [median 662 days, interquartile range (IQR) 364 - 1116 days], 35 (21.6%) patients experienced a re-exploration for bleedings. The median time from a CF-LVAD implantation to re-exploration for bleedings was 6 days (IQR 1 - 10 days). In multivariate logistic regression analysis, a post-operative platelet count was the independent predictor for a re-exploration for bleedings after CF-LVAD implantation (per 104/μl: odds ratio 0.82, 95% confidence interval 0.74 - 0.91, p < 0.001). Patients who experienced a re-exploration for bleedings had a significantly worse survival rate compared with patients who did not (At 4 years 73.6% vs. 90.1%, p = 0.039). A re-exploration for bleedings is prevalently needed after CF-LVAD implantation, especially in patients with low post-operative platelet counts. As bleedings requiring a re-exploration were associated with poor prognosis, the risk stratification using post-operative platelet counts may be beneficial for patients who underwent CF-LVAD implantation.