Continuous-flow Left Ventricular Devices Research Articles

(92) Greater Burden of Biventricular Dysfunction in Female Recipients of Continuous-Flow Left Ventricular Devices

(92) Greater Burden of Biventricular Dysfunction in Female Recipients of Continuous-Flow Left Ventricular Devices

Outflow cannula alignment in continuous flow left ventricular devices is associated with stroke.

We sought to evaluate whether differences in left ventricular assist device (LVAD) canula alignment are associated with stroke. There is a paucity of clinical data on contribution of LVAD canulae alignment to strokes. We conducted a retrospective analysis of patients who underwent LVAD implantation at Houston Methodist hospital from 2011 to 2016 and included those who had undergone cardiac computed tomography (CT) with contrast. LVAD graft alignment using X-ray, echocardiography, and cardiac CT was evaluated. The primary outcome was stroke within 1 year of LVAD implantation. Of the 101 patients that underwent LVAD Implantation and cardiac CT scan during the study period, 78 met inclusion criteria. The primary outcome occurred in 12 (15.4%) patients with a median time to stroke of 77 days (interquartile range: 42-132 days). Of these, 10 patients had an ischemic and two had hemorrhagic strokes. The predominant device type was Heart Mate II (94.8%). Patients with LVAD outflow cannula to aortic angle lesser than 37.5° and those with outflow graft diameter of anastomosis less than 1.5 cm (assessed by cardiac CT) had significantly higher stroke risk (p < 0.001 and p = 0.01 respectively). In HMII patients, a lower LVAD speed at the time of CT scan was associated with stroke. Further studies are needed to identify optimal outflow graft configuration to mitigate stroke risk.

Results of non-elective withdrawal of continuous-flow left ventricular assist devices in selected patients

Protocols have been developed to identify patients for elective withdrawal of continuous-flow left ventricular device (cfLVAD) support. However, little is known about non-elective explantation or decommissioning of cfLVADs. A retrospective analysis of all patients who underwent left ventricular assist device (LVAD) explantation or decommissioning at a single center between 2002 and 2021 was performed. Sixty-one patients underwent withdrawal of a cfLVAD (HeartMate II [Abbott] n=17, HeartMate 3 [Abbott] n=2, HeartWare HVAD [Medtronic] n=36, INCOR [Berlin Heart] n=6). The median follow-up after withdrawal was 1,039 days. The survival at 5 years was 76.1% (95% CI: 64.2%-95.2%). Predictors of worse outcomes in univariate regressive analysis were the duration of heart failure and the age at LVAD implantation. Of the 61 patients, 40 underwent elective withdrawal following a specific protocol. The other twenty-one patients underwent non-elective withdrawal of the cfLVAD because of device infection (n=12), device thrombosis (n=6), device malfunction (n=2) or due to acute intracerebral bleeding (n=1), also with an excellent survival at 5 years of 81.3%. (95% CI: 63.8-1). The withdrawal was performed in these patients even though they did not fulfill established criteria for successful explantation or decommissioning like clinical stability (n=21), left ventricular end-diastolic diameter ≤ 55 mm (n=3), performance of right heart catheterization (n=6), or pulmonary artery wedge pressure ≤ 15 mm Hg (n=3). Non-elective withdrawal is possible in selected patients after discussion in a team of experienced cardiac surgeons, cardiologists, technicians, and VAD coordinators. The appropriate preoperative assessment before decommissioning or explantation of a cfLVAD warrants further investigation.

Perioperative Pectoralis Muscle Mass and Attenuation Estimated by Computed Tomography are Not Predictors for Mortality after Heart Transplantation

Purpose End-stage heart failure (HF) is often associated with malnutrition and sarcopenia, both of them are related to adverse HF outcomes. Skeletal muscle mass and attenuation are predictors of mortality after continuous flow left ventricular devices (LVAD) implantation. Our purpose was to assess the prognostic impact of skeletal muscle mass on patients undergoing heart transplantation (HT). Methods Retrospective study of a single-center HT population, between 2009 and 2019. Patients > 18 years-old with a computed chest scan in the previous 6 months before HT were included. Multiorgan transplants were excluded. Unilateral pectoralis muscle mass indexed (PMMi) to body surface area and attenuation (by mean Hounsfield units [PHUm]) were measured in each patient. HT patients were classifiedin tertiles according to PMMi and PHUm and characteristics of patients were compared by Chi-square, t-student and Kruskall-Wallis. Multivariate Cox regression analyses were performed to assess the impact of preoperative PMMi and PHUm on survival after HT. Results 132 patients were included, mean age 58.9, 16.7% female, median follow-up 3.67 years (interquartile range 1.7-5.9 years). 41.7% of patients underwent urgent HT (1.5% INTERMACS 1 situation, 15.2% INTERMACS 2 and 28% INTERMACS 3). Both PMMi and PHUm were lower in females and for lowest weight recipients. Urgent HT frequency was similar between tertiles of PMMi, but recipients in the higher tertile of PHUm were more frequently transplanted in an urgent status (38.2% vs 21.8% in the lowest tertile, p= 0.029). 26 patients (19.7%) died during follow-up, 12 (9.1% of total cohort) during HT admission. In the Cox regression analyses, neither PMMi (HR 1.034, 95% CI 0.891-1.2, p= 0.659) nor PHUm (HR 1.02, 95% CI 0.992-1.050, p=0.160) were associated with an increased mortality. Only the needed of mechanical circulatory support and hemofiltration after HT were associated with a higher risk of death. Conclusion Among this single-center HT recipients population, neither lower PMMi nor lower PHUm were associated with worse outcomes after HT.

Sex Specific Utilization and Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices

<h3>Purpose</h3> We explored if utilization of continuous flow (CF-LVADS) has increased amongst females in the age of new-generation devices, which are smaller and more durable. We also compared outcomes between female and male CF-LVAD recipients. <h3>Methods</h3> The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) was queried to identify 20,324 CF-LVAD recipients from June 2008 to December 2017, of which 4350 (21.4%) were female and 15,974 (78.6%) were male. Survival was compared after propensity matching for age ≥ 50 yr, heart failure etiology, body surface area, INTERMACS class, co-morbidities, device strategy as destination or bridge to transplant therapy, temporary mechanical circulatory support, and device type. <h3>Results</h3> In 2008, women made up 22.5% of CF-LVAD recipients but that decreased to 20.9% in 2016 (Figure 1a). After propensity matching, baseline characteristics were comparable between 2463 females and 3925 males with the exception of mean right atrial pressure / pulmonary capillary wedge pressure which was higher in women (0.50 vs 0.45, p<0.001) and pulmonary artery pulsatility index, which was lower in women (2.0 vs 2.2, p=0.001) (Table 1). A competing risk analysis showed women had similar 1 year survival but significantly worse late survival (Figure 1b). Women also had higher rates of permanent right VAD support after CF-LVAD implantation (2.8% vs 2.0%, p=0.04). <h3>Conclusion</h3> Women with heart failure are far less likely to receive CF-LVADs and despite propensity matching, women are more likely to present with right heart failure at time of implantation. The higher mortality risk may be due to women presenting with more advanced heart failure at time of referral for CF-LVAD.

Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and meta-analysis

Gastrointestinal bleeding (GIB) especially from arteriovenous malformations (AVM) remains one of the devastating complications following continuous-flow left ventricular device (CF-LVAD) implantation. Blockade of angiotensin II pathway using angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) was reported to mitigate the risk of GIB and AVM-related GIB by suppressing angiogenesis. We performed a systematic review and meta-analysis to evaluate the association between ACEI/ARB treatment and GIB in CF-LVAD population. Comprehensive literature search was performed through December 2019. We included studies reporting risk of GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB with those who did not. Data from each study were combined using the random-effects to calculate odd ratios and 95% confidence intervals. Three retrospective cohort studies were included in this meta-analysis involving 619 LVADs patients (467 patients receiving ACEI/ARB). The use of ACEI/ARB was statistically associated with decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22-0.56, I2 = 0.0%, p < 0.001). There was a non-significant trend toward lower risk for AVM-related GIB in patients who received ACEI/ARB (pooled OR 0.46, 95% CI 0.19-1.07, I2 = 51%, p = 0.07). Larger studies with specific definitions of ACEI/ARB use and GIB are warranted to accurately determine the potential non-hemodynamic benefits of ACEI/ARB in CF-LVAD patients.

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

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.

Characteristics, Therapeutic Needs, and Scope of Patients With a Continuous-Flow Left Ventricular Device Entering Cardiac Rehabilitation: A RETROSPECTIVE ANALYSIS.

With an increasing number of left ventricular assist devices (LVADs) being implanted, the need for adequate cardiac rehabilitation (CR) regimens meeting the special needs of these patients arises. Only a few studies have reported experience gained on this topic. Structured CR strategies are poorly implemented. The aim was to evaluate the characteristics, therapeutic needs, and scope of LVAD patients at admission to CR within a greater cohort in order to identify their special CR needs. Retrospective single-center study; 69 LVAD patients (50.7 ± 13.6 y; 59 male; 48 HVAD; 21 HeartMate II) who completed first inpatient CR were included. Patient records were used to document relevant medical information (including the results of a 6-min walk test and a maximal isometric strength test for quadriceps femoral muscles in both legs) and the International Classification of Functioning, Disability and Health for classification of health and health-related domains. Patient characteristics demonstrated a heterogeneous group: CR was started 44 ± 38.6 d after implantation; CR duration was 28 ± 9.7 d. Despite similar etiology, physical and psychological condition was diverse, although, overall a high degree of impairment was present, especially in the body function (79.7%) and activity and participation (95.7%) domains. The results demonstrated the need for a highly individualized approach in the somatic and also in the education, psychosocial, and social therapeutic regimes. The results demonstrate a heterogeneous group with a high level of impairment and special needs in many CR domains. The development and evaluation of a special highly individualized approach of CR, which meets the special needs of these patients, is needed.

3277Impact of congestion in worsening renal failure after implantation of a centrifugal, continuous-flow left ventricular device

3277Impact of congestion in worsening renal failure after implantation of a centrifugal, continuous-flow left ventricular device

Effect of Outflow Graft Size on Flow in the Aortic Arch and Cerebral Blood Flow in Continuous Flow Pumps: Possible Relevance to Strokes.

One of the most devastating complications of continuous flow left ventricular devices (CFLVADS) is stroke, with a higher incidence in HeartWare Ventricular Assist Device (HVAD) as compared with HEARTMATE II. The reason for the observed difference in stroke rates is unclear. Because outflow graft diameters are different, we hypothesized that this could contribute to the difference in stroke rates. A computational fluid-structure interaction model was created from the computed tomography (CT) scan of a patient. Pressures were used as the boundary condition and the flow through the cerebral vessels was derived as outputs. Flow into the innominate artery was very sensitive to the anastomosis angle for a 10 mm as compared with a 14 mm graft, with the net innominate flow severely compromised with a 10 mm graft at 45° angle. Aortic insufficiency seems to affect cerebral blood flow nonlinearly with an 80% decrease at certain angles of outflow graft anastomosis. Arterial return in to the arch through a narrow graft has important jet effects and results in significant flow perturbations in the aortic arch and cerebral vessels and stasis. A 10 mm graft is more sensitive to angle of insertion than a 14 mm graft. Under some conditions, serious hypoperfusion of the innominate artery is possible. Aortic incompetence results in significant decrease of cerebral blood flow. No stasis was found in the pulsatile flow compared with LVAD flow.

Neuentwicklungen der Herzunterstützungssysteme – Möglichkeiten und Grenzen

Advanced Heart failure is worldwide an increasing problem. Implantation of mechanical circulatory support devices (MSCD) in the latter patients and especially the implantation of left ventricular assist devices (LVAD) is nowadays an established therapeutic option for advanced heart failure and becoming a more and more realistic alternative to heart transplantation (HTX. There are a number of different treatment options for these patients, such as bridge to transplantation (BTT), bridge to candidacy (BTC), bridge to recovery (BTR) and the destination therapy (DT) option. The latter option has become more frequent during the last years as a consequence of a rising number of older patients with terminal heart failure requiring therapy whilst not being eligible for HTX. These factors have led to a rapid increasing number of LVAD implantations and centers performing these strategies. Survival rates and quality of live have improved since the introduction of smaller, intra-pericardial and more durable continuous flow left ventricular devices. Though improvements in LVAD pump-design and durability have been made, most common complications for these patients are still device related problems, such as coagulation disorders, gastrointestinal bleeding, device related infection, pump thrombosis or cerebrovascular accidents. However, some questions still remain unanswered or are still under debate such as the exact timepoint for LVAD implantation. In addition aspects such as better biocompatibility to reduce device related problems are still a major challenge for the upcoming LVAD era. This paper will concentrate on the different treatment options and LVAD systems and their outcome, current trends in the LVAD development and the limitations of the devices for the patients.

(834) - Primary Graft Dysfunction After Cardiac Transplantation Following Continuous-Flow Left Ventricular Device Support

Primary graft dysfunction (PGD) is the most catastrophic complication after cardiac transplantation. However, little is known about PGD in patients who are bridged with contemporary continuous-flow left ventricular assist devices (LVAD). Between May 2004 and December 2013, 145 patients underwent cardiac transplantation after continuous-flow LVAD support as a bridge to transplant at our center. Degree of PGD was classified into mild, moderate, and severe according to recently published the International Society for Heart and Lung Transplantation consensus statement. The mean age of the study cohort was 54 ± 14 years, 81% were male, and 35% were ischemic etiology. The median duration of LVAD support before transplantation was 205 days. Thirty-six patients (25%) developed PGD (mild 4, moderate 22, severe 10) within 24 hours after transplantation. For severe PGD, biventricular assist device was used in all patients. Mean left ventricular ejection fraction immediately after transplantation was 57 ± 5.6% in non-PGD, 45 ± 9.5% in mild/moderate PGD, and 13 ± 10% in severe PGD group (p<0.0001). In-hospital mortality in non-PGD, mild/moderate PGD, and severe PGD were 5.5%, 7.7%, and 60%, respectively (p=0.002). The 1-year post-transplant survival in non-PGD, mild/moderate PGD, and severe PGD were 91%, 92%, and 25%, respectively (p<0.0001). PGD after bridge with continuous-flow LVAD is common. Patients who developed severe PGD had a dismal outcome. A multi-center study including large cohort is warranted to extend our findings.

Gastrointestinal bleeding after continuous-flow left ventricular device implantation: review of pathophysiology and management.

Gastrointestinal bleeding is one of the most common complications in patients with continuous-flow left ventricular assist devices. Though the exact pathophysiology is still unclear, continuous-flow physiology, acquired Von Willebrand disease, and formation of arteriovenous malformations in the gastrointestinal tract are implicated. An individualized plan of endoscopic therapy and anticoagulation management is required when caring for these patients.

Aortic Valve Function Under Support of a Left Ventricular Assist Device: Continuous vs. Dynamic Speed Support.

Continuous flow left ventricular devices (CF-LVADs) support the failing heart at a constant speed and alters the loads on the aortic valve. This may cause insufficiency in the aortic valve under long-term CF-LVAD support. The aim of this study is to assess the aortic valve function under varying speed CF-LVAD support. A Medtronic freestyle valve and a Micromed DeBakey CF-LVAD were tested in a mock circulatory system. First, the CF-LVAD was operated at constant speeds between 7500 and 11,500 rpm with 1000 rpm intervals. The mean pump outputs obtained from these tests were applied in varying speed CF-LVAD support mode using a reference model for the pump flow. The peak of the instantaneous pump flow was applied at peak systole and mid-diastole, respectively. Ejection durations and in the aortic valve were the longest when the peak pump flow was applied at mid-diastole among the CF-LVAD operating modes. Furthermore, mean aortic valve area over a cardiac cycle was highest when the peak pump flow was applied at mid-diastole. The results show that changing phase of the reference flow rate signal may reduce the effects of the CF-LVADs on altered aortic valve closing behavior, without compromising the overall pump support level.

Mechanical circulatory support devices as destination therapy-current evidence.

Advanced heart failure is an increasing problem worldwide. Nowadays, mechanical circulatory support devices (MSCD) are an established therapeutic option for terminal heart failure after exhaustion of medical and conventional surgical treatment, and are becoming a realistic alternative to heart transplantation (HTX). There are a number of different treatment options for these patients, such as bridge to transplantation (BTT), bridge to candidacy (BTC), bridge to recovery (BTR) and the destination therapy (DT) option. The latter option has become more frequent throughout the last years, due to a donor organ shortage and an increasing number of older patients with terminal heart failure who are not eligible for HTX. These factors have led to a rapidly increasing number of LVAD implantations as well as centers which perform these procedures. This has also been due to improved LVAD survival rates and quality of life following the introduction of smaller, intrapericardial and more durable continuous flow left ventricular devices. The most common complications for these patients are device-related problems, such as coagulation disorders, gastrointestinal bleeding, device related infection, pump thrombosis or cerebrovascular accidents. However, some questions still remain unanswered or under debate, such as the exact time-point for LVAD implantation. In addition, aspects such as better biocompatibility for LVADs remain a major challenge. This review will concentrate on DT for terminal heart failure and provide an overview of the current evidence for LVAD implantation in this patient group, with particular emphasis on indication and time-point of implantation, choice of LVADs, and long term outcomes and quality of life.

Does Renal Dysfunction and Method of Bridging Support Influence Heart Transplant Graft Survival?

Renal insufficiency is common in status 1B patients supported with inotropes or a continuous flow left ventricular device (CF-LVAD) as a bridge to heart transplantation. We evaluated the association of renal function and inotrope versus CF-LVAD support on posttransplant graft survival in status 1B patients. The Scientific Registry for Transplant Recipients database was analyzed for posttransplant survival in status 1B patients bridged with inotropes or CF-LVAD who underwent transplantation between 2003 and 2012. Pretransplant renal function was measured by estimating glomerular filtration rate (GFR) and was stratified as less than 45 mL · min(-1) · 1.73 m(-2), 45 to 59, and 60 or greater. Univariate Kaplan-Meier and multivariate Cox regression models were used to evaluate the main effects of GFR strata and inotropes versus CF-LVAD, and the interaction effect of GFR strata by CF-LVAD, on graft survival. This study included 4,158 status 1B patients (74% male, aged 53 ± 12 years). Of those, 659 patients had a CF-LVAD (HeartMate-II [Thoratec, Pleasanton, CA], n = 638; HVAD [HeartWare, Framingham, MA], n = 21), and 3,530 were receiving inotropes (31 CF-LVAD patients were also receiving inotropes). Kaplan-Meier analyses demonstrated reduced graft survival (p = 0.022) in patients with pretransplant GFR less than 45 versus GFR 45 to 59 (p = 0.062) and versus GFR 60 or greater (p = 0.007), and no effect of inotrope versus CF-LVAD support on graft survival (p = 0.402). Multivariate analysis demonstrated that, after adjusting for the main effects of GFR stratum, CF-LVAD, and inotropes, status 1B patients bridged with a CF-LVAD and GFR in the lowest stratum had reduced graft survival (interaction effect p = 0.040). Pretransplant renal insufficiency was associated with reduced posttransplant graft survival in status 1B patients. This risk is increased for patients bridged with a CF-LVAD (versus inotropes) who have GFR in the lowest stratum.

Sex-Specific Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices as a Bridge to Transplantation or Destination Therapy

Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting. In addition, females have been underrepresented in most multicenter randomized controlled trials for mechanical circulatory support (MCS). The objective of our study was to analyze our experience implanting 130 continuous-flow LVADs and to determine the impact of sex on survival. We identified 130 patients who underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on sex. Variables were compared using two-sided t-tests, χ2 tests, Cox proportional hazards models, and log-rank tests to determine whether there was a difference between the two groups and if sex was a significant independent predictor of outcome. Of the 130 patients, 35 were females and 95 were males. Female patients had worse pre-LVAD cardiac output and cardiac index and were more likely to be on MCS at the time of implantation. Male patients had worse renal function. Survival was analogous for both cohorts with 30 day, 6 month, 1 year, and 2 year survivals of 97%, 90.8%, 90.8%, and 84.3%, respectively, for female patients versus 94.7%, 87.9%, 78.4%, and 72.8%, respectively, for male patients. The incidence of other LVAD-related complications was also similar in both groups. Gender did not predict postoperative mortality on univariate analysis. Contrary to most published reports, female and male LVAD patients have similar postoperative and midterm survival, length of hospital stay, readmission rates, and postoperative complications. It appears that females have gained more benefit from newer generation devices compared to males.

Continuous Flow Left Ventricular Devices Significantly Unload the Pulmonary Vasculature Regardless of the Severity of Mitral Regurgitation

Purpose Ventricular unloading with continuous flow LVADs (CFLVAD) has been correlated with reduction of pulmonary artery pressures (PAP) during support. The impact of severity of mitral regurgitation on the observed reduction in PAPs has not been defined. The necessity of additional surgical interventions on the mitral valve in patients with moderate or severe MR during LVAD implantation is controversial. Further, the magnitude of improvement in severity of MR in CFLVAD is undefined. Methods and Materials From January 2009 to January 2012, 245 patients underwent placement of CFLVAD (HeartMate2, HeartWare) at our institution. We compared preoperative right heart hemodynamics and echocardiograms to long term post support echocardiography with complete follow-up in 200 patients (82%). Results Average time from implant to long term study was 262±317 days. After CFLVAD placement, 94.5 % of patients had improvement or no change in MR and 5.5% of patient had worse MR. Improvement of ≥ to one grade was seen in 76.5 % (153/200) patients. Furthermore, 61.5 % (123/200) of patients had ≥2 grade improvement and 60% of patients had no MR or a 3 grade improvement (p Conclusions Heart failure patients with moderate to severe MR have significant reductions in MR after CFLVAD. CFLVADs significantly unload the pulmonary vasculature, regardless of the degree of MR. Mitral valve procedures may not be necessary in addition to LVAD implantation to achieve long term pulmonary vascular decompression in the patients with moderate to severe MR. Pre-operative MR Grade Pre-Operative MR (patients) Severe Moderate Mild Trivial/None Pre-op PASP Long Term PASP Severe (65) 9% 15% 40% 35% 58± 14 33± 10 Moderate (60) 5% 18% 33% 45% 59 ±12 31± 11 Mild (58) 0% 9% 33% 59% 57± 15 32± 12 Trivial/None (17) 0% 0% 18% 82% 52 ± 12 30 ± 10 Improvement of MR from baseline in all groups (p

Utility of concomitant tricuspid valve procedures for patients undergoing implantation of a continuous-flow left ventricular device

Patients referred for implantable continuous-flow left ventricular assist devices (cfLVAD) frequently have preoperative right heart failure and tricuspid regurgitation (TR). The objective of this report is to examine early clinical benefits of concomitant tricuspid surgery for these patients. Sixty-one of 200 consecutive cfLVAD patients at our institution displayed preimplant right heart dysfunction and significant TR. Thirty-three underwent cfLVAD plus a tricuspid valve procedure (TVP), and 28 had cfLVAD alone. Preimplant characteristics and clinical outcomes were retrospectively studied. As previously described, post-LVAD right ventricular failure was defined as need for right ventricular assist device (RVAD) support or greater than 14 days of intravenous inotropic support. Preimplant characteristics were similar between the 2 groups. Cardiopulmonary bypass time was increased for the group that received concomitant TVPs. The most common TVP consisted of an undersizing ring annuloplasty. The cfLVAD-alone group had greater TR after implant relative to the cfLVAD+TVP group. The cfLVAD-alone group experienced greater postprocedure right ventricular failure relative to cfLVAD+TVP (46.4% vs 18.2%; P < .05). Furthermore, prolonged hospitalization was increased for the cfLVAD-alone group versus the cfLVAD+TVP. Survival was similar between the 2 groups. Concomitant TVP appears to reduce postprocedure right ventricular failure for patients with significant TR undergoing cfLVAD implantation.

31 Pump-Related Infections (PRI) after Implantation of Continuous-Flow Left Ventricular Devices (CF LVADs): Analysis of 2900 Patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)

31 Pump-Related Infections (PRI) after Implantation of Continuous-Flow Left Ventricular Devices (CF LVADs): Analysis of 2900 Patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)