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Is implantable cardioverter defibrillator surgery in patients with an implanted left ventricular assist device safe under uninterrupted oral anticoagulation?
Author(s) -
Vondran Maximilian,
Aspern Konstantin,
Garbade Jens,
Lässing Johannes,
Kiefer Philipp,
Rastan Ardawan Julian,
Borger Michael Andrew,
Schroeter Thomas
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.14217
Subject(s) - medicine , perioperative , heparin , vitamin k antagonist , implantable cardioverter defibrillator , surgery , thrombosis , ventricular assist device , adverse effect , warfarin , heart failure , atrial fibrillation , cardiology
Abstract Background Implantable cardioverter‐defibrillator (ICD) surgery in patients with implanted left ventricular assist devices (LVAD) is associated with an increased risk of bleeding complications because of the need to ensure that these patients are adequately anticoagulated. Our study aimed to evaluate the safety of our new strategy of uninterrupted oral anticoagulation compared to heparin‐bridging during the surgical interval. Methods Between January 2009 and January 2020, 116 patients with LVAD underwent ICD surgery. Since January 2015, 60 patients were operated under continued sufficient oral anticoagulation with a vitamin k antagonist (VKA group). Fifty‐six patients underwent a heparin‐bridging regimen (heparin group). Demographics, perioperative data, complications, and mortality were analyzed. Results Bleeding complications attributable to the surgical intervention occurred more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re‐exploratory surgery (14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical significance. Moreover, the heparin group patients' postoperative total length of stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were no procedure‐related deaths, no thromboembolic events, and no LVAD‐related thrombosis. Conclusion Our strategy of uninterrupted oral anticoagulation is safe and results in a reduction by more than half the number of days in hospital without an increase in adverse events.