Outcomes after Concomitant Procedures with Left Ventricular Assist Device Implantation: Implications by Device Type and Indication: From the Mechanical Circulatory Support Network

Guidelines for performing concomitant procedures (CPs) in patients undergoing continuous flow left ventricular assist device (CF-LVAD) implantation are unclear. The impact of an increased surgical complexity outside the constraint of landmark clinical trials has not been reported.From May 2004 to December 2013, 614 patients (499 male, 81%) underwent continuous-flow LVAD implant at our institutions. Median age was 57±13 years and 364 (59%) were bridge to transplantation (BTT). Survival and device-related complications were analyzed and stratified based on the surgical intervention.398 patients (65%) underwent CF-LVAD implantation without CPs. The remaining patients (35%, n=216) were grouped according to various CPs. Survival was comparable between groups and not influenced by the CP, device type, or indication for implant. Time-to-first device-related adverse event was shorter in patients with CPs. Regression analysis revealed only increased age (p=0.03), increase in baseline creatinine (p=0.002), cardiopulmonary bypass time (p=0.03), and decreased body mass index (p=0.03) were predictors of mortality, while only age (p=0.006) and prior sternotomy (p=0.02) were related to adverse device-related events.Performing CPs leads to comparable survival and device-related outcomes after implant. The decision to perform CPs should be balanced with age, preoperative renal dysfunction, and projected complexity of surgery.