Is it Possible to Implant and Manage Patients with Durable LVADs Who Refuse Blood Products?

Abstract

Purpose Bloodless left ventricular assist device (LVAD) implantation is rarely performed in patients who refuse blood products under all circumstance including death. The aim of this study is to investigate a single center's experience with these patients regarding LVAD implantation and long term management. Methods This is a retrospective review from a single center academic institution of all patients who refused blood products and received LVADs from 2012 to 2018. Demographics, readmissions, length-of-stay, hemoglobin, INR, distance traveled for therapy, adverse events and overall survival were investigated. Results Total patients N=18. Blood products administered 0. Demographics: 10 (55%) male; age 59+/-11; 76% African American; 82% Intermacs 1-2; miles traveled for therapy 408+/- 366. Operative: devices HVAD 72%, HM2 28%; reoperation sternotomy 33%; concomitant valve procedures 88%; length of stay 22 +/-12 days. Early and late adverse events see table 1. Survival: 30 days 100%, 1 year 88%, 2 year 72%, mean duration of support 2.3 years. Conclusion This study showed that LVADs can be implanted and managed successfully in patients who refuse blood products with severe cardiogenic shock and high surgical complexity. Both short term and long term management is feasible. Refusal of blood products is not a contraindication for LVAD implantation. Bloodless left ventricular assist device (LVAD) implantation is rarely performed in patients who refuse blood products under all circumstance including death. The aim of this study is to investigate a single center's experience with these patients regarding LVAD implantation and long term management. This is a retrospective review from a single center academic institution of all patients who refused blood products and received LVADs from 2012 to 2018. Demographics, readmissions, length-of-stay, hemoglobin, INR, distance traveled for therapy, adverse events and overall survival were investigated. Total patients N=18. Blood products administered 0. Demographics: 10 (55%) male; age 59+/-11; 76% African American; 82% Intermacs 1-2; miles traveled for therapy 408+/- 366. Operative: devices HVAD 72%, HM2 28%; reoperation sternotomy 33%; concomitant valve procedures 88%; length of stay 22 +/-12 days. Early and late adverse events see table 1. Survival: 30 days 100%, 1 year 88%, 2 year 72%, mean duration of support 2.3 years. This study showed that LVADs can be implanted and managed successfully in patients who refuse blood products with severe cardiogenic shock and high surgical complexity. Both short term and long term management is feasible. Refusal of blood products is not a contraindication for LVAD implantation.