Low Operative Mortality With Implantation of a Continuous-Flow Left Ventricular Assist Device and Impact of Concurrent Cardiac Procedures

Abstract

Background— The objective of this study was to determine the impact of concurrent cardiac procedures (CCP) on patient outcomes after HeartMate II (HMII) left ventricular assist device implantation. Methods and Results— Two hundred eighty-one patients underwent implantation of a HMII as a bridge to transplantation from March 2005 to March 2007. One hundred seventy patients had an HMII implanted only, and 81 patients underwent concurrent cardiac procedures in conjunction with HMII implantation (HMII+CCP). Of these, 47 patients had concurrent valvular procedures, 15 patients had simultaneous closure of patent foramen ovale, and 19 patients had other various cardiac procedures. Patients requiring right ventricular assist device support or noncardiac procedures were excluded. Preoperative characteristics were similar for patients with and without concurrent cardiac procedures. Overall 30-day mortality was 5.8% for the HMII group and 11.3% for the HMII+CCP group. Subgroup analysis demonstrated that simultaneous patent foramen ovale closure was not associated with an increased 30-day mortality rate, but concurrent valvular procedures increased the risk to 8.5%. Patients who underwent an aortic valve procedure had a 30-day mortality rate of 25%, higher than for isolated concurrent mitral (0%) or tricuspid repair (3.3%). Survival at 180 days was 87% for HMII alone and 80% for HMII+CCP. The hazard ratio for concurrent cardiac procedures adjusted for baseline parameters was 1.82 (95% CI, 1.07 to 3.10, P =0.026). Conclusions— There is a low 5.8% operative mortality rate for patients requiring uncomplicated HMII implantation, with no apparent increased risk for concurrent patent foramen ovale closure or mitral or tricuspid repair. However, concurrent aortic valve and other cardiac procedures are associated with significantly decreased perioperative and long-term survival.