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Impact of left ventricular inspection employing cardiopulmonary bypass on outcome after implantation of left ventricular assist device
Author(s) -
Lewin Daniel,
Nersesian Gaik,
Roehrich Luise,
Mueller Marcus,
Mulzer Johanna,
Stein Julia,
Kukucka Marian,
Starck Christoph,
Schoenrath Felix,
Falk Volkmar,
Ott Sascha,
Potapov Evgenij V.
Publication year - 2022
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.14145
Subject(s) - medicine , cardiopulmonary bypass , ventricular assist device , perioperative , extracorporeal , intensive care unit , ventricle , patent foramen ovale , ejection fraction , extracorporeal circulation , surgery , anesthesia , intracardiac injection , circulatory system , cardiology , heart failure , percutaneous
Abstract Background Cardiopulmonary bypass (CPB) during left ventricular assist device (LVAD) implantation provides circulatory support and allows for safe inspection of the left ventricle (LV), whereas circulatory support by veno‐arterial extracorporeal life support (va‐ECLS) or off‐pump implantation may reduce postoperative bleeding and inflammatory response. Methods Retrospective analysis of 616 consecutive adult patients who received an LVAD via median sternotomy between January 1, 2015 and December 31, 2019. All patients undergoing concomitant intracardiac procedures other than closure of persistent foramen ovale or atrial septal defect and redo surgeries were excluded from the analysis. The remaining patients ( n = 222) were divided into two groups and 1:1 propensity score‐matched regarding preoperative parameters: patients who underwent LVAD implantation with LV inspection employing CPB (CPB group, n = 62) and without LV inspection on va‐ECLS or off‐pump (non‐CPB group, n = 62). Results The groups were well balanced with regard to preoperative baseline characteristics (standard difference <0.1). Patients in the CPB group required more blood transfusions (median 2 vs. 0 units, p = 0.031) during surgery and in the first 24 h afterwards. The median intensive care unit stay was longer in the CPB group (18 vs. 11 days, p = 0.021). The CPB group showed an absence of perioperative stroke and a smaller number of events per patient‐year for postoperative ischemic stroke (0.02 vs. 0.12, p = 0.003). 30‐day survival (87% vs. 87.1%) and 1‐year survival (80.3% vs. 74%) were similar in both groups ( p = 0.78). Conclusion Visual LV inspection on CPB may reduce the risk of postoperative ischemic stroke. Despite the negative effects of employing CPB in lieu of other intraoperative strategies, survival was similar in both groups.