Impact of left ventricular inspection employing cardiopulmonary bypass on outcome after implantation of left ventricular assist device

Daniel Lewin; Gaik Nersesian; Luise Roehrich; Marcus Mueller; Johanna Mulzer; Julia Stein; Marian Kukucka; Christoph Starck; Felix Schoenrath; Volkmar Falk; Sascha Ott; Evgenij V Potapov

doi:10.1111/aor.14145

Impact of left ventricular inspection employing cardiopulmonary bypass on outcome after implantation of left ventricular assist device

Artif Organs. 2022 May;46(5):908-921. doi: 10.1111/aor.14145. Epub 2021 Dec 26.

Authors

Daniel Lewin¹, Gaik Nersesian^{1

2}, Luise Roehrich^{1

2

3}, Marcus Mueller¹, Johanna Mulzer¹, Julia Stein¹, Marian Kukucka⁴, Christoph Starck^{1

2}, Felix Schoenrath^{1

2}, Volkmar Falk^{1

2

5

6

7}, Sascha Ott⁴, Evgenij V Potapov^{1

2}

Affiliations

¹ Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
² DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
³ German Heart Foundation, Frankfurt am Main, Germany.
⁴ Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany.
⁵ Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
⁶ Berlin Institute of Health (BIH), Berlin, Germany.
⁷ Translational Cardiovascular Technologies, Department of Health Sciences and Technology, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.

PMID: 34904259
DOI: 10.1111/aor.14145

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.

Keywords: LVAD; cardiopulmonary bypass; off-pump; outcome; stroke; va-ECLS.

MeSH terms

Adult
Cardiopulmonary Bypass
Extracorporeal Membrane Oxygenation* / methods
Heart Ventricles
Heart-Assist Devices* / adverse effects
Humans
Retrospective Studies
Treatment Outcome