Abstract
Left ventricular assist device (LVAD) failure can present as an acute complication requiring prompt diagnosis and treatment with pump exchange (PE). We thought to characterize indication and outcomes of LVAD PE in our institution.
A total of 240 continuous flow LVAD were implanted between 2011 and July 2018. We performed a retrospective analysis of 24 LVAD PE performed on 20 patients, including indication for LVAD PE, time on support to first and second pump exchange, pump type, surgical approach, and operative outcomes.
Of 240 CF LVAD implants performed over 7 years, 24 (10%) represented pump exchange. Patient age was 47 (17-86) years at time of first implant, and all patients were male. A total of 24 LVAD PE were performed on 20 patients. Time on support until first LVAD PE was 548.3 days (41-1345), and to second LVAD PE was 225 days (13-456).Indications included pump thrombosis in 18 (90%) patients, and pump malfunction in 2 (10%) patients.Type of LVAD PE included 15 / 169 Heart Mate II (HMII)(8.8%), and 9 / 69 HeartWare (HW) (13%) (p<0.05). Time on support to first pump exchange was 516 days (41-1221), and 603 days (357-1345) for HMII and HW respectively.Operative approach involved median sternotomy on 11 (45%), subcostal approach on 10 (41%), and limited left thoracotomy on 3 (14%) patients. Postoperative survival to hospital discharge was 95% after first LVAD PE, and 100% after second LVAD PE. Major postoperative complications included surgical bleeding requiring open chest with delayed closure (n=4), renal insufficiency requiring hemodialysis (n=5), and recurrence of driveline infection (n=6). Of 19 patients discharged after first LVAD PE, 5 (26%) underwent heart transplantation after LVAD PE, and 5 of the remaining 14 patients (36%) were alive at 2 years after first LVAD PE.
LVAD PE is a safe and effective therapy for patients presenting pump thrombosis or device malfunction. About 20% of patients will require a second LVAD PE within a year.
