Increased Incidence of Cholecystitis with Total Artificial Heart versus Left Ventricular Assist Device

Abstract

Cholecystitis after mechanical circulatory support (MCS) implantation is possibly related to hemodynamic changes related to continuous peripheral blood flow. Visceral hypoperfusion is also a reported risk factor. We aimed to evaluate the incidence of cholecystitis in non-pulsatile LVAD vs pulsatile TAH devices. We reviewed data from all durable MCS patients at a single large center from 2011 through 2019. The primary endpoint was cholecystitis requiring surgery. We reviewed explanted gallbladder pathology, the length of time between implantation and cholecystectomy, as well as INTERMACS profile at time of MCS. 11 out of 151 (7.3%) LVAD patients required cholecystectomy versus 18 out of 93 (19.4%) TAH patients, p-value 0.004. While cholecystectomies occurred earlier in patients with TAH vs LVAD, it was not statistically significant p 0.251. Wilcoxon Ranked Sum Test showed that surgical interventions occurred earlier in acute acalculous cholecystitis (ACC) than in calculous cholecystitis (CC) Z=151, p<0.003. More patients were INTERMACS profile 1 at time of implant with TAH (52.7%) vs LVAD (20.5%), p<0.001. There was a significantly higher incidence of cholecystitis requiring surgery in the pulsatile (TAH) vs non-pulsatile (LVAD) MCS devices. Surgical intervention occurred earlier in patients with ACC versus CC. This may be related to both biventricular failure and higher acuity at time of implant in TAH patients.