Impact of Cardiopulmonary Bypass for Implantation of Left Ventricular Assist Device on Postoperative Outcome

Objectives: The need for circulatory support during left ventricular assist device (LVAD) implantation is subject to debate. Cardiopulmonary bypass (CPB) with the use of the heart–lung–machine provides circulatory support, allows for safe inspection of the left ventricle and intracardiac procedures. Circulatory support by extracorporeal life support (ECLS) or off-pump implantation may reduce postoperative bleeding and inflammatory response.

Methods: Retrospective analysis of 1:1 propensity score matched adult patients who underwent LVAD implantation via median sternotomy between 01/2015 and 12/2019 on CPB for closure of PFO and/or ASD or by surgeon's preference (CPB group, n = 62) and on ECLS or off-pump (no CPB group, n = 62). All patients with concomitant intracardiac procedures other than closure of PFO or ASD and redo surgeries were excluded from the analysis.

Result: The groups were well balanced with regard to preoperative baseline characteristics (standard difference <0.1). The median surgery duration was longer in the CPB group (172 vs. 143 minutes, p < 0.001). The median chest tube output during the first 24 hours after surgery was similar in both groups (785 [507.50, 1,306.25] mL vs. 800 [550.00, 1,192.50] mL, p = 0.904). Reoperation for bleeding was necessary in 17.7% (CPB) versus 12.9% (no CPB) of patients, respectively (p = 0.29). Patients in the CPB group required more blood transfusions (median: 2.00 [0.00, 6.00] vs. 0.00 [0.00, 2.75] units, p = 0.031) during the operation and in the first 24 hours after surgery. Postoperatively, 21 (33.9%) patients in the CPB group and 14 (22.6%) in the no CPB group required renal replacement therapy (p = 0.231). A temporary right ventricular assist device was necessary in 11.3 vs. 8.1% of patients, respectively (p = 0.504). The number of events per patient-year for postoperative stroke was 0.03 versus 0.064, respectively (p = 0.409). Thirty-day survival (87 vs. 88.7%) and 1-year survival (80.2 vs. 74.8%) were similar in both groups (p = 0.74).

Conclusion: LVAD implantation off-pump or with the use of ECLS is feasible and safe. Avoiding CPB leads to less blood product use in the first 24 hours postoperatively.

Publication History

Article published online:
19 February 2021