title: Impact of concomitant cardiac procedures performed during implantation of long-term left ventricular assist devices.
abstract: BACKGROUND
  There is a paucity of data evaluating the effect of performing a concomitant cardiac procedure (CCP) on peri-operative survival in patients undergoing implantation of long-term left ventricular assist devices (LVADs). The objective of this study was to review our single-institutional experience with patients who underwent a CCP during implantation of a long-term continuous-flow LVAD.
  
  
  METHODS
  From March 2006 through June 2012, 130 patients underwent implantation of a LVAD. Of these, 76 (58.5%) were implanted as bridge-to-transplant and 54 (41.5%) as destination therapy. The LVAD implantation was isolated in 95 patients and with CCP in 35. This included 19 tricuspid valve repairs, 14 aortic valve repair/replacements, and 2 patent foramen ovale closures. The LVAD only and LVAD+CCP groups were compared regarding pre-operative demographics, peri-operative and midterm survival, and the incidence of post-operative complications.
  
  
  RESULTS
  Pre-operative central venous pressure (p = 0.047), moderate to severe tricuspid regurgitation (p = 0.011), cardiopulmonary bypass time (p < 0.0001), cross-clamp time (p < 0.0001), and right ventricular end diastolic diameter (p = 0.039) were higher in the CCP group. Body mass index (p = 0.01) and body surface area (p = 0.037) were higher in the LVAD-only group. Peri-operative and midterm survival at 30 days, 6 months, 1 year, and 2 years was 94%, 87%, 80%, and 73%, respectively, for isolated LVAD implants vs. 97%, 90%, 86%, and 86%, respectively, for LVAD+CCP (p = NS). Survival was similar for LVAD patients with tricuspid valve repairs, with aortic valve repair, and with patent foramen ovale repair (p = NS). Cox proportional hazard models showed a CCP was not an independent predictor of outcome (p = NS).
  
  
  CONCLUSIONS
  CCPs performed during implantation of a long-term continuous-flow LVADs does not increase peri-operative or mid-term mortality. In addition, unlike previous reports, there was no additive procedural risk for patients undergoing concomitant aortic valve repair or replacement.
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Arielle
authors.initials: A
authors.lastname: Hodari
authors.forename: Joseph
authors.initials: J
authors.lastname: Karam
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D015897:Comorbidity; D005260:Female; D054092:Foramen Ovale, Patent / Q000453:epidemiology / Q000601:surgery*; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*
keywords: LVAD; concomitant cardiac procedures; left ventricular assist device; outcomes