Objective

Left ventricular assist device implantation is associated with relatively high incidence of bleeding and right ventricular failure (RVF). These adverse events increase resource use, hospital stay and compromise survival. An off-pump implant technique without using intra-operative systemic heparin was developed to reduce these adverse events. Early outcomes of patients implanted with the HeartWare HVAD using cardiopulmonary bypass (CPB) or the heparin-free off-pump implant technique were compared.

Methods

A retrospective analysis of 57 consecutive patients who underwent HeartWare HVAD implantation from October 2009 to October 2015 was carried out. Demographic and perioperative clinical variables were analyzed using Fisher’s exact test and Wilcoxon Rank-Sum test. HeartWare HVADs were implanted using CPB (Group CPB, n = 34) or the heparin-free off-pump technique (Group HFOP, n = 23); in the latter group, 7 were performed with a full sternotomy and 16 with mini-sternotomy and left mini-thoracotomy.

Results

Group HFOP had high mean trans-pulmonary gradient and INTERMACS profile. Postoperatively (op), in Group HFOP none required FFP or platelets and only 56.5% had Red Cell transfused where as in Group CPB 79.5% had Red Cell and38.3% had FFP or Platelets (P=0.005). Post op bleeding and chest re-exploration was significantly (P=0.007) higher in Group CPB. Incidence of RVAD and ICU stay in the were trended lower in HFOP group (P<0.069). 30-day mortality was 4.9% Group HFOP versus 2.9% in Group CPB (P=1).

Conclusion

Heparin-free off-pump implantation of HVAD in patients with higher INTERMACS profile is associated with less bleeding, blood product usage and a trend towards less RV failure and shorter ICU stay. Use of this technique should be further explored in a larger clinical trial.