Placement of a Fully Magnetically Levitated Left Ventricular Assist Device: Intrathoracic versus Intrapericardial

Abstract

A fully magnetically levitated centrifugal-flow left ventricular assist device can be placed in either the intra-thoracic cavity or the intra-pericardial cavity. This study aimed to investigate the clinical impact of pump location in patients following fully magnetically levitated left ventricular assist device (LVAD) placement. We retrospectively reviewed 161 patients who received fully magnetically levitated centrifugal-flow LVAD at our center between November 2014 and August 2019. Pump location was determined from the operative record and CT scan images if available. We identified 77 patients (48%) with intra-thoracic placement (Group T) and 84 patients (52%) with intra-pericardial placement (Group P). Clinical outcomes were compared between the groups. Patients in Group T were older (61 vs. 57 years, p=0.05), more likely to have prior sternotomy (27% vs. 11%, p=0.008), and more frequently INTERMACS class I (21% vs. 5.9%, p=0.008) compared with patients in Group P. Incidence of perioperative right ventricular assist device (RVAD) was significantly lower in Group T (23% vs. 38%, p=0.045). In-hospital mortality was 8.6% in Group T vs. 3.6% in Group P (p=0.15). Kaplan-meier curve analysis showed 2-year survival of 83% in Group T and 93% in Group P (p=0.15). Multivariate logistic regression analysis demonstrated INTERMACS class I was an independent predictor of RVAD use (OR 16.9, 95% CI 5.09-56.2, p<0.01) but Group P was not a predictor (p=0.2). In our study, intrathoracic vs. intrapericardial fully magnetically levitated centrifugal-flow pump placement did not affect overall clinical outcomes.