There are not enough hearts to go around. And so, durable left ventricular assist devices (LVADs) play an integral role in the support of patients with advanced heart failure. In this mini oral abstract session
, different surgical technologies are explored for their impact on mechanical circulatory support (MCS) outcomes.
Less Invasive Left Ventricular Assist Device Implantation is Safe and Feasible in Patients with Smaller Body Surface Area
Katherine L. Wood, MD
, University of Rochester Medical Center, Rochester, NY USA
In this retrospective single-center analysis, 32 patients with body surface area (BSA) 1.8m2 or less were compared with 184 patients with BSA > 1.8m2 who underwent LVAD implantation. The smaller BSA cohort had significantly more women (50% vs 13%, p<0.001) and decreased pump flow (4.1 vs 4.6 L/min, p<0.001) and speed (5200 vs 5400 rpm, p<0.001) at discharge. No differences were seen in terms of post-operative complications, hospital length of stay, and survival to discharge or 6 months after implantation.
Exploring the Benefit of Thoracotomy LVAD Implant on Subsequent Sternal Entry for Heart Transplantation
Sam Emmanuel, MBBS, BHSc (Hons)
, St Vincent's Hospital (Sydney), Darlinghurst, Australia
2:1 propensity-matched analysis of 12 thoractomy vs 24 sternotomy patients who had LVAD insertion were evaluated for impact of the primary surgical technique at LVAD implantation on subsequent heart transplantation at this single center. No difference was noted in between-group baseline or peri-operative characteristics, nor in post-operative outcomes including mortality, length of stay or need for dialysis. 83% of patients were male, aged 58-60 years old with a BMI of 27.
Optimization of Flow Dynamics During the HeartWare HVAD to HeartMate 3 Exchange: A Computational Study Assessing Differential Surgical Techniques
Jonathan Grinstein, MD
, University of Chicago, Chicago, IL USA
With HeartWare LVAD discontinuation, this study sought to identify the optimal surgical configuration for connecting the 10 mm HVAD outflow graft to the 14 mm HM3 outflow graft. The study evaluated 4 variations of the outflow cannula, including anastomoses near the pump or aorta, from the aorta or along the entire cannula using computational flow dynamic models. The highest maximum velocity occurred in the configuration with longer 10 mm graft, resulting in greater blood volume exposed to very high shear rate and greater right and left coronary flows. This will become important in patients needing revision of the HearWare LVAD to the HM3 LVAD.
Hemodynamic Response and Periprocedural Right Ventricular Function During a Lateral Thoracotomy versus Median Sternotomy Surgical Approach to Implantation of a Left Ventricular Assist Device - A Pilot Study
Jay D. Pal, MD, PhD
, University of Washington, Seattle, WA USA
In this pilot study, 21 patients were randomized to receive LVAD implant via median sternotomy (MS) vs lateral thoracotomy (LT) on cardiopulmonary bypass. In the MS vs LT group, right atrial pressure but not mean pulmonary artery pressures decreased along with contractility.
Impact of Concomitant Cardiac Valvular Surgery During Implantation of Continuous-Flow Left Ventricular Assist Devices: A European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Analysis
Antonio Loforte, MD, PhD
, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
In this EUROMACs analysis (2006-2018), 533 of 2760 LVAD patients had concomitant valvular surgical procedures that significantly increased pump and OR time (p<0.001). Although no difference was seen in mortality (e.g., hospital (p0.074) or 1-, 3- and 5-year (p=0.25) survival) there was greater associated morbidity: longer ICU stay (p<0.0001), duration of mechanical ventilation (p=0.001), temporary right VAD support (p=0.033) and need for dialysis (p=0.014).
Bridging to Transplant with HeartMate 3 Left Ventricular Assist Device in the 2018 Heart Allocation System
Matan H. Uriel, MD
, Columbia University Irving Medical Center, NYC, NY USA
The new heart allocation system revised the priority status of patients on LVAD support to status 3 or 4. This analysis compared its impact on adults with HM3 durable LVAD in the UNOS registry before and after the new heart allocation system. Fewer patients with HM3 were waitlisted in the post-allocation change era (449 vs 1094 patients). And though there was no difference in heart transplant rates (p=0.76) and death or delisting for worsening status (p=0.43) at one year after listing, one-year survival post-transplant was significantly lower (p<0.001) in the new vs old heart allocation system. Predictors of post-transplant graft survival by multivariable analysis included age >60 years, ischemic etiology, poor functional status, renal dysfunction (>1.8 mg/dL), pulmonary hypertension and listing in the new allocation system.
Predictors of Failure to Rescue After Left Ventricular Assist Device Implantation
James W. Stewart II, MD
, University of Michigan, Ann Arbor, MI USA
Of 13,617 patients with primary LVAD implantation in the STS Intermacs database (2012-2017), there were 4,839 patients who had major post-operative complications of which 854 patients had failure to rescue (FTR). This interesting analysis identified four pre-op predictors of FTR after durable LVAD implant: CABG or valve surgery (OR 1.5), dialysis (OR 2.3) and ECMO (OR 4.3). Those with post-op complications of right heart failure (75%), reintubation (45%), major infection (39%) and dialysis (34%) had the highest FTR, highlighting potential avenues for earlier targeted post-operative care interventions.
Characterizing Outflow Graft Narrowing over Time
Sean McCarthy, MD
, Wayne State, Detroit, MI USA
This interesting study of 72 LVAD patients supported with HM2 or HM3 over a median of 1230 days demonstrated a median of 7% narrowing of the outflow graft over time. Time from device implant (p<0.001) but not wrapping of the outflow graft (p=0.071) was associated with this narrowing over time. There was no correlation of outflow graft narrowing with survival (HR 1.04), stroke (0.94), HF hospitalization (HR 1.06) or VAD alarms (HR 0.93).
Evaluation of the Stanford Integrated Psychosocial Assessment for Transplantation on Clinical Outcomes Following Left Ventricular Assist Device Implantation
Dongbo Yu, MD, PhD
, University of Chicago, Chicago, IL USA
This retrospective single-center analysis of 145 durable LVAD implants (1/2010-4/2020) demonstrated no correlation of the SIPAT score, a validated psychosocial risk assessment tool, with survival (1 year, p=0.888; 3 years p=0.743) or freedom from readmission (3 years, p=0.389) between the 3 different patient groups (SIPAT score <6 [excellent] vs 6-20 [good] vs >20 [acceptable or poor]). The SIPAT score was not found to be a significant predictor for survival (at 1 year, HR 0.995, p=0.897; at 3 years, HR 0.989, p=0.66). The majority of patients were male (68%) who had a mean age of 55 years and mean SIPAT score of 12.4.
– Summary by Varinder Kaur Randhawa, MD, PhD