Single‐Center Experience With HeartMate II Left Ventricular Assist Device Explantation

In patients with continuous flow left ventricular assist devices (CF‐LVADs) myocardial recovery is uncommon. Given the heterogeneity of the population implanted and low incidence of recovery, the discovery of native left ventricular (LV) recovery and criteria for explantation of CF‐LVAD system is not clearly determined. We sought to analyze the characteristics of the patients who underwent CF‐LVAD explantation at our institution. Prospectively collected data on patients supported with CF‐LVADs were reviewed retrospectively. Patients who underwent CF‐LVAD explants were identified and their characteristics were analyzed with a focus on patient presentation and determinants of explantability. From November 2006 to June 2014, 223 patients (181 male, 42 female) underwent implantation of HeartMate II LVAD. Seven female (16.7%) and one male (0.6%) patients were explanted (P < 0.001). Mean age was 43 ± 9 years and etiology for cardiomyopathy was ischemic in three (37.5%) patients, nonischemic in four (50%) patients, and mixed in the one (12.5%) male patient of the cohort. Five (62.5%) patients presented acutely with significant hemolysis, and were found to have LV improvement as well as reduced, absent, or reversed diastolic flow velocities on echocardiography. Overall, mean lactate dehydrogenase level before explantation was 1709 ± 1168 U/L compared to the mean baseline level of 601 ± 316 U/L (P = 0.048). Mean LV ejection fraction (LVEF) improved from 17 ± 7% preimplant to 56 ± 11% pre‐explantation (P < 0.001). Median number of days on CF‐LVAD support was 870 (interquartile range, 209–975) while mean duration of follow‐up after the CF‐LVAD explantation was 276 ± 240 days. Mean LVEF dropped from 46 ± 19% postexplantation to 34 ± 10% during the most recent follow‐up (P = 0.015). At our institution, patients who underwent LVAD explants were predominantly women with nonischemic cardiomyopathy. Clinical evidence of hemolysis and echocardiographic evidence of reduced or absent diastolic flow velocities were common findings in these patients. Over time, patient's native LV function declined in the absence of LVAD (after LVAD explantation). Significant challenges remain in predicting LV recovery and identifying those individuals who have recovered myocardial function significant enough to be explanted.     

Electromagnetic interference between implantable cardiac devices and continuous-flow left ventricular assist devices: a review

Journal of Interventional Cardiac Electrophysiology - Many patients with continuous-flow left ventricular assist devices (CF-LVAD) have other, co-existing implantable cardiac devices. While such...     

Single versus multi‐drug antimicrobial surgical infection prophylaxis for left ventricular assist devices: A systematic review and meta‐analysis

Infection remains the Achilles heel of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen has not been established. This study evaluated the efficacy of a single‐drug SIP compared to a multi‐drug SIP on clinical outcomes in patients undergoing continuous‐flow LVAD (CF‐LVAD) and pulsatile LVAD (P‐LVAD) implantation. An electronic search was performed to identify studies in the English literature on SIP regimens in patients undergoing LVAD implantation. Identified articles were assessed for inclusion and exclusion criteria. Fourteen articles with 1,311 (CF‐LVAD: 888; P‐LVAD: 423) patients were analyzed. Overall, 501 (38.0%) patients received single‐drug SIP, whereas 810 (62.0%) received multi‐drug SIP. Time to infection was comparable between groups. There was no significant difference in overall incidence of LVAD‐specific infections [single‐drug: 18.7% vs. multi‐drug: 24.8%, P = 0.49] including driveline infections [single‐drug: 14.1% vs. multi‐drug: 20.8%, P = 0.37]. Compared to single‐drug SIP, patients who received multi‐drug SIP had a significantly lower survival rate [single‐drug: 90.0% vs. multi‐drug: 76.0%, P = 0.01] and infection‐free survival rate [single‐drug: 88.4% vs. multi‐drug: 77.3%, P = 0.04] at 90 days. However, there were no significant differences in 1‐year survival and 1‐year infection‐free survival between groups. No survival differences were observed in the CF‐LVAD subset as well. This study demonstrated no additional advantage of a multi‐drug compared to a single‐drug regimen for SIP. Although there was a modest advantage in early survival among CF‐LVAD and P‐LVAD patients who received single‐drug SIP, there were no significant differences in the 1‐year survival and 1‐year infection‐free survival.     

Comparison of cardiothoracic surgery training in usa and germany

Background  

Training of cardiothoracic surgeons in Europe and the United States has expanded to incorporate new operative techniques and requirements. The purpose of this study was to compare the current structure of training programs in the United States and Germany.