Continuous-flow left ventricular assist device exchange: clinical outcomes.
BACKGROUND
A percentage of patients with a left ventricular assist device (LVAD) require device exchange. Although this is an important clinical entity, there are only a handful of relevant studies on this topic in the literature.


METHODS
From 2004 to 2012, 30 device exchanges (HeartMate II to HeartMate II) were performed. Since June 2011, we have employed the subcostal approach for device exchange if indicated. Sixteen patients underwent device exchange through a subcostal approach (S group), whereas 14 patients had devices exchanged through a full sternotomy (F group). Pre- and post-operative data were retrospectively reviewed.


RESULTS
There was no difference in baseline patient characteristics between the two groups. Overall, mean duration between primary surgery and device exchange was 425 ± 407 days. Surgical indications included device thrombus/hemolysis (N = 19), device malfunction (N = 9) and infection (N = 2). Cardiopulmonary bypass time was significantly shorter in the S group (S: 40 ± 23 minutes, F: 105 ± 84 minutes; p < 0.05), and post-operative bleeding within 24 hours after surgery was less in the S group (S: 362 ± 367 ml, F: 1,286 ± 971 ml; p < 0.05). Length of ICU stay was significantly shorter in the S group (S: 4.6 ± 1.8 days, F: 8.2 ± 4.9 days; p < 0.05). There was no difference in post-operative complications, except for prolonged intubation (F: N = 6 [43%], S: N = 1 [6.3%]; p < 0.05). There were 3 deaths in the F group and 0 in the S group, with no statistical difference (p = 0.09). Also, there was no significant difference in other outcomes, including transplantation, device explantation and ongoing LVAD support.


CONCLUSIONS
A subcostal approach may be preferred for HeartMate II device exchange if indicated.
Division of Cardiothoracic Surgery, Department of Surgery, New York, New York. Electronic address: to2226@columbia.edu.
Takeyoshi
T
Ota
Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
Halit
H
Yerebakan
Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
Hirokazu
H
Akashi
Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
Hiroo
H
Takayama
Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
Nir
N
Uriel
Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
Paolo C
PC
Colombo
Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
Urich P
UP
Jorde
Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
Yoshifumi
Y
Naka
D000328:Adult; D000368:Aged; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D007239:Infections / Q000150:complications; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000379:methods* / Q000401:mortality*; D013927:Thrombosis / Q000150:complications; D018487:Ventricular Dysfunction, Left / Q000628:therapy*
device exchange; device malfunction; device thrombus; left ventricular assist device; minimally invasive; subcostal approach