Off-Pump Implantation of Left Ventricular Assist Devices - A Single Center Experience

Abstract

<h3>Purpose</h3> In the past decades, survival after left ventricular assist device (LVAD) implantation has improved notably due to technical improvements of the implantable devices and refined peri- and postoperative patient management. It has been suggested that further benefits could be achieved by avoiding cardiopulmonary bypass and thus its associated negative effects such as systematic inflammatory response syndrome. Therefore, we evaluated safety and feasibility of off-pump LVAD implantation. <h3>Methods</h3> A retrospective analysis of our patient cohort in the time span from 2012 to 2019 was performed. During that time period a total of 275 adult LVAD implantations were done. Of those, 3 patients were excluded due to loss of follow-up giving a final patient population of 272 patients (HeartWare n=128, HeartMate II n=40, HeartMate III n=104). Primary outcomes of interest were 30-day, 90-day and one-year all-cause mortality; secondary outcomes included ICU length of stay, ventilation- and catecholamine support time and peri-operative complications stratified by implantation method. <h3>Results</h3> The overall population is mostly male (86%) with a medium age of 64 (IQR 14.5) and 63.2% of ischemic etiology. We identified 35 patients (12.9%) who received off-pump LVAD implantation. Baseline characteristics between off-pump and on-pump implanted patients did not differ in respect to INTERMACS levels, comorbidities or end-organ function at time of surgery. Off-pump implanted patients were implanted more commonly with an HVAD device (p=0.01) and in all cases via a less invasive surgical approach avoiding full sternotomy (p<0.001). However, this difference is explained by the different surgical technique when performing an off-pump implantation and the smaller size of the HVAD device. No significant differences in mortality were observed, neither in the first 30 days (6.8% vs. 2.9%, p=0.37), 90 days (13.9% vs. 11.4%, p=0.64) nor one year after LVAD implantation (28.3% vs. 22.9%, p=0.41). Also no differences in ICU length of stay, ventilation times or time on catecholamine support were observed. The occurrence of perioperative complications based on the INTERMACS adverse event definition was similar in both groups. <h3>Conclusion</h3> Off-pump LVAD implantation is safe and feasible, and the one-year survival rate is comparable to that of conventional on-pump implantation.