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Left Thoracotomy Upper Hemisternotomy Left Ventricular Assist Device (LVAD) Implantation Offers Safe, Durable Option for Patients with Prior Sternotomy Undergoing LVAD Implantation
Abstracts Table 2.
S367 Postoperative Outcomes
Operative time (min) CPB Time (min) Conversion to sternotomy RVAD ≥4 intraop RBCs (units) Reop for bleeding Operative mortality Hospital LOS (days)
CS (n=52)
LTHS (n=60)
264 (214-346) 84 (66-134) N/A 12 (23%) 18 (35%) 12 (23%) 11 (21%) 22 (15-50)
304 (276-355) 69 (56-89) 2 (3%) 1 (2%) 11 (18%) 5 (8%) 3 (5%) 16 (13-24)
p-value 0.01 0.001 − <0.001 0.04 0.04 0.02 0.001
922 Less Invasive HeartMate 3 Implantation is Safe and Reproducible with Excellent Outcomes I. Gosev, K. Wood, B.C. Ayers, H. Vidula, J. Alexis, N. Kumar, J. Delehanty, B. Barrus, P. Knight, L. Chen and S. Prasad. University of Rochester, Rochester, NY. Purpose: The purpose of this study was to analyze early outcomes, safety and reproducibility of the less invasive HeartMate 3 implantation technique. Methods: Retrospective review of prospectively collected data was performed on 53 consecutive patients implanted with left ventricular assist devices between February and September 2018 at a single institution. Patients were excluded if they were enrolled in a study requiring full sternotomy (3 patients), were a pump exchange (5 patients) or were implanted with the HeartWare device (4 patients). Safety outcomes included return to the operating room and overall survival. Results: A total of 41 patients were included in the study. Thirty-nine patients were implanted with the complete sternal-sparing technique while two had an upper hemi-sternotomy with small left anterior thoracotomy. Average age was 53.6§13.9 years, 76% were male and 41% were INTERMACS Profile 1. Twelve patients (29%) had a right ventricular stoke work index less than 400. Nine patients (22%) were implanted off VA ECMO and 10 patients (24%) had previous cardiac surgery. All patients that qualified for the procedure were implanted using a less invasive technique. No patients required conversion to full sternotomy. Two patients (5%) returned to the operating room for bleeding. Twenty patients (49%) received a perioperative packed red blood cell transfusion within 24 hours of surgery. Median blood loss in the first 24-hours was 1042 mL (IQR=768-1307 mL). 2 patients (5%) requiring RVAD support. Median intubation time was 16 hours (IQR=9-34 hours). Median intensive care unit and hospital length of stay were 4 days (IQR=2-6 days) and 15.5 days (IQR=12-23 days), respectively. Thirty-day survival was 39/41 (95%). Conclusion: Less invasive HeartMate 3 implantation in our single center setting is safe and reproducible with excellent outcomes. Multicenter studies are required to further validate this technique. 923 Approaches to Repairing Outflow Graft Stenosis in Left Ventricular Assist Devices V. Kagan,1 C. Mehta,1 E. Michel,1 A. Ward,1 A. Jivan,2 M. Ricciardi,2 A. Anderson,2 D.T. Pham,1 and J. Rich.2 1Division of Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL; and the 2Division of Cardiology, Northwestern Memorial Hospital, Chicago, IL. Purpose: Durable Left Ventricular Assist Devices (LVAD) are typically implanted with an inflow cannula in the LV apex and an outflow graft anastomosed to the aorta. We describe 4 pts who experienced clinically significant outflow graft stenosis requiring intervention, an underreported but likely increasingly common complication in pts on long term support with a VAD. Methods: A retrospective review of our VAD database was performed on pts implanted with a durable VAD at our institution from 2011-2018. Results: Four pts were found to have stenosis of the outflow graft confirmed by CT angiogram (Figure). Each of the pts presented with symptoms of acute on chronic LV failure with a decrease in VAD flows,
prompting the diagnostic evaluation. The pre-VAD etiology of heart failure was nonischemic cardiomyopathy for 3 pts and transposition of the great arteries with VAD implanted into the systemic ventricle in the 4thpatient. Mean time from implant to diagnosing the stenosis was 722 days. In all pts the cause of the stenosis was external compression from accumulation of fluid or hematoma between the gore-tex applied at the time of implant and the outflow graft. The stenosis was focal in three and diffuse in one pt. Two of the pts were successfully treated with stenting of the outflow graft and one pt was taken for surgical release of the goretex. In the 4thpt, the stenosis was an incidental finding as we diagnosed acute thrombus ingestion into the inflow cannula which resolved with thrombolytics. All pts experienced an immediate increase in >2L of VAD flow following each, respective, intervention. Conclusion: Outflow graft stenosis in VADs is a serious complication that can lead to decompensated heart failure, the cause of which may be external compression related to gore-tex around the graft. This complication should be included in the differential diagnosis of a drop in VAD flows, and while treatable, should prompt a reassessment of how gore-tex is applied (if at all) at the time of implant.
924 Left Thoracotomy Upper Hemisternotomy Left Ventricular Assist Device (LVAD) Implantation Offers Safe, Durable Option for Patients with Prior Sternotomy Undergoing LVAD Implantation N.M. Foley,1 S. Zalawadiya,2 M. Kuzemchak,1 K. Balsara,1 J. Menachem,2 K. Schlendorf,2 S. Maltais,3 A. Shah,1 and M. Danter.1 1Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN; 2Cardiology, Vanderbilt University Medical Center, Nashville, TN; and the 3Cardiac Surgery, Mayo Clinic, Rochester, MN. Purpose: Increasingly, patients undergoing LVAD implantation have had previous cardiac surgery, and re-operative sternotomy LVAD implantation can pose certain technical challenges. The approval of the thoracotomy approach for LVAD implantation potentially offers increased flexibility of access and may mitigate some of these technical challenges. Thus we reviewed our series of patients with previous sternotomy and who underwent left thoracotomy and upper hemisternotomy LVAD implantation. Methods: Data were compiled on all patients who had consented to be included in the Advanced Heart Failure Registry, at Vanderbilt University Medical Center, between January 2013 and October 2018. Patients who had had previous sternotomy and thoracotomy HeartWareTM HVAD LVAD implantation were included in the analysis. Patients who had undergone thoracotomy HeartMate II (N=3), or off-pump thoracotomy HVAD implantation (N = 9) were excluded from the analysis. The operative technique for all patients involved a limited left anterolateral thoracotomy with an upper hemi-sternotomy anastomosis to the ascending aorta. Preoperative, Intra-operative and post-operative clinical and VAD specific variables were reported. Data regarding clinical end points were analyzed at 30 days and one year following implant.
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The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
Results: 19 patients satisfied the inclusion criteria, and their characteristics are described in Table 1. One patient died 11 days post LVAD implantation due to multi-system organ failure. This patient was INTERMACS 1 at implant with multi-organ failure pre-operatively. All other patients were either transplanted or still on LVAD support one year following implant. Conclusion: The use of the left thoracotomy upper hemisternotomy approach for LVAD implantation in patients with previous sternotomy is a safe alternative to re-operative sternotomy.
Complete sternal sparing approach compared to reoperative sternotomy Complete Reoperative Sternal-Sparing Sternotomy (n=10) p-value (n=7) Age Male sex BMI INTERMACS 1 Intraoperative Data Cardiopulmonary Bypass Time (min) Delayed closure Outcomes Survived to discharge Overall complications Unplanned return to OR Renal failure requiring dialysis Hepatic failure Severe RV failure Mechanical ventilation time (hr) Intensive Care Unit length of stay (days) Hospital length of stay (days) Thirty-day readmissions
56.1 §11.0 6 (86%) 25.2 §4.6 4 (57%)
64.7 §5.9 9 (90%) 29.7 §6.7 3 (30%)
0.055 1.000 0.146 0.350
151.3 §61.5 5 (71%)
127.7 §24.3 2 (20%)
0.285 0.058
4 (57%) 6 (86%) 2 (29%) 4 (57%) 3 (43%) 4 (57%) 48 [10-96] 14 [4.5-32] 32.5 [20.5-61.5] 0 (0%)
9 (90%) 3 (30%) 1 (10%) 1 (10%) 0 (0%) 0 (0%) 13 [10-42] 4 [3-6] 13 [12-24] 0 (0%)
0.250 0.050 0.537 0.101 0.051 0.015 0.473 0.104 0.218 1.000
926 Concurrent Mitral Valve Repair during Placement of Continuous-Flow Left Ventricular Assist Device M. Cevasco, Y. Naka, A. Saha, A.R. Garan, L. Witer, J. Sanchez, P. Kurlansky, A. Melehy, J. Fried, M. Yusefpolskaya, P. Colombo, H. Takayama and K. Takeda. Columbia University Medical Center, New York, NY.
925 Complete Sternal-Sparing Technique Improves Outcomes and Decreases RV Failure Compared to Re-Operative Sternotomy B.C. Ayers, F. Sagebin, K. Wood, H. Vidula, J. Alexis, B. Barrus, S. Prasad and I. Gosev. University of Rochester, Rochester, NY. Purpose: Patients with a history of previous sternotomy often pose difficult surgical challenges for subsequent cardiac procedures. We hypothesized that the less invasive complete sternal-sparing approach would demonstrate favorable outcomes compared to full sternotomy (FS) for patients with a history of previous sternotomy. Methods: We retrospectively reviewed all patients implanted with a HeartMate 3 (HM3) at our institution from September 2017 through September 2018 (n=63). Patients were included if they had history of prior sternotomy and separated into groups based on LVAD implantation technique: CSS versus re-operative sternotomy. Preoperative characteristics and postoperative outcomes were compared between cohorts. Results: Of the 17 (30%) HM3 patients with a history of previous sternotomy, 10 (59%) were implanted via CSS and 7 (41%) by re-operative sternotomy. The CSS cohort tended to be older (65§6 vs 56§11 years, p = 0.055) and more likely to have undergone CABG (80% vs 14%, p = 0.015) while the FS cohort was more likely to have undergone previous aortic valve replacement (71% vs 10%, p = 0.035) (Table). The CSS cohort demonstrated fewer overall complications (30% vs 86%, p = 0.050) including a decreased incidence of severe right ventricular failure (0% vs 57%, p = 0.015). There was a trend towards shorter ICU length of stay (median, [IQR]; 4 [3-6] vs 14 [4.5-32] days, p = 0.218), total hospital length of stay (13 [12-24] vs 32.5 [20.5-61.5] days, p = 0.104) and improved 30-day survival (90% vs 57%, p = 0.250) in the CSS cohort. Conclusion: LVAD implantation via CSS approach demonstrates fewer complications and decreased incidence of severe right ventricular failure in patients undergoing re-operative cardiac surgery. The CSS approach is our preferred surgical implantation technique for this patient population.
Purpose: Pre-existing mitral valve pathology is common in patients undergoing continuous-flow left ventricular assist device (LVAD) implantation. Best management of pre-existingmitral valve disease remains controversial. Methods: Between March 2004 and December 2017, a total of 594 patients received a continuous-flow left ventricular assist device. Of these, a total of 93 patients (16%) underwent a concurrent mitral valve repair, either with an Alfieri stitch via the left ventricular (LV) apex coring site (n =30, 32%) or with an annuloplasty ring via a left atriotomy (n = 63, 68%). Outcomes were compared between patients who received an Alfieri stitch and those who received an annuloplasty ring repair. Results: All patients had moderate or greater mitral regurgitation at the time of LVAD implantation. Median age was 54 years (interquartile range [IQR], 43-74) in the annuloplasty cohort, and 56 years (interquartile range [IQR], 44-79) in the Alfieri stitch group. A proportionately greater number of women underwent Alfieri stitch repair (n = 6, 20%) compared to ring annuloplasty (n = 5, 8%; p= 0.01). Additionally, a greater number of patients in the Alfieri group underwent a concomitant valve intervention such as a Park stitch or tricuspid repair (n = 15, or 50%) compared to those patients undergoing a ring annuloplasty (n = 28, 44%; p= 0.04). Cardiopulmonary bypass times were shorter on average in the Alfieri patients, independent of concomitant valve procedure (111 minutes versus 134 minutes, p = .02). Thirty-day survival in the Alfieri group (n = 27, 90%) was similar to that of the ring annuloplasty group (n = 57, 91%); p > 0.05. However, in the 84 patients for whom data was available, 1-year survival was higher in the Alfieri group compared to the ring annuloplasty group (26.3% versus 18.6%, p= 0.032). Conclusion: Concomitant mitral valve intervention is fairly common in patients undergoing continuous-flow LVAD placement. Our findings suggest that short-term outcomes are not impacted by type of mitral valve repair technique, but mitral valve repair via the LV apex coring site may be a favorable approach. 927 Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation K. Zhigalov, A. Mashhour, M. Szczechowicz, S. Mkalaluh, J. Ennker, H. Eichstaedt and A. Weymann. Department of Cardiac Surgery, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
S367 Postoperative Outcomes
Operative time (min) CPB Time (min) Conversion to sternotomy RVAD ≥4 intraop RBCs (units) Reop for bleeding Operative mortality Hospital LOS (days)
CS (n=52)
LTHS (n=60)
264 (214-346) 84 (66-134) N/A 12 (23%) 18 (35%) 12 (23%) 11 (21%) 22 (15-50)
304 (276-355) 69 (56-89) 2 (3%) 1 (2%) 11 (18%) 5 (8%) 3 (5%) 16 (13-24)
p-value 0.01 0.001 − <0.001 0.04 0.04 0.02 0.001
922 Less Invasive HeartMate 3 Implantation is Safe and Reproducible with Excellent Outcomes I. Gosev, K. Wood, B.C. Ayers, H. Vidula, J. Alexis, N. Kumar, J. Delehanty, B. Barrus, P. Knight, L. Chen and S. Prasad. University of Rochester, Rochester, NY. Purpose: The purpose of this study was to analyze early outcomes, safety and reproducibility of the less invasive HeartMate 3 implantation technique. Methods: Retrospective review of prospectively collected data was performed on 53 consecutive patients implanted with left ventricular assist devices between February and September 2018 at a single institution. Patients were excluded if they were enrolled in a study requiring full sternotomy (3 patients), were a pump exchange (5 patients) or were implanted with the HeartWare device (4 patients). Safety outcomes included return to the operating room and overall survival. Results: A total of 41 patients were included in the study. Thirty-nine patients were implanted with the complete sternal-sparing technique while two had an upper hemi-sternotomy with small left anterior thoracotomy. Average age was 53.6§13.9 years, 76% were male and 41% were INTERMACS Profile 1. Twelve patients (29%) had a right ventricular stoke work index less than 400. Nine patients (22%) were implanted off VA ECMO and 10 patients (24%) had previous cardiac surgery. All patients that qualified for the procedure were implanted using a less invasive technique. No patients required conversion to full sternotomy. Two patients (5%) returned to the operating room for bleeding. Twenty patients (49%) received a perioperative packed red blood cell transfusion within 24 hours of surgery. Median blood loss in the first 24-hours was 1042 mL (IQR=768-1307 mL). 2 patients (5%) requiring RVAD support. Median intubation time was 16 hours (IQR=9-34 hours). Median intensive care unit and hospital length of stay were 4 days (IQR=2-6 days) and 15.5 days (IQR=12-23 days), respectively. Thirty-day survival was 39/41 (95%). Conclusion: Less invasive HeartMate 3 implantation in our single center setting is safe and reproducible with excellent outcomes. Multicenter studies are required to further validate this technique. 923 Approaches to Repairing Outflow Graft Stenosis in Left Ventricular Assist Devices V. Kagan,1 C. Mehta,1 E. Michel,1 A. Ward,1 A. Jivan,2 M. Ricciardi,2 A. Anderson,2 D.T. Pham,1 and J. Rich.2 1Division of Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL; and the 2Division of Cardiology, Northwestern Memorial Hospital, Chicago, IL. Purpose: Durable Left Ventricular Assist Devices (LVAD) are typically implanted with an inflow cannula in the LV apex and an outflow graft anastomosed to the aorta. We describe 4 pts who experienced clinically significant outflow graft stenosis requiring intervention, an underreported but likely increasingly common complication in pts on long term support with a VAD. Methods: A retrospective review of our VAD database was performed on pts implanted with a durable VAD at our institution from 2011-2018. Results: Four pts were found to have stenosis of the outflow graft confirmed by CT angiogram (Figure). Each of the pts presented with symptoms of acute on chronic LV failure with a decrease in VAD flows,
prompting the diagnostic evaluation. The pre-VAD etiology of heart failure was nonischemic cardiomyopathy for 3 pts and transposition of the great arteries with VAD implanted into the systemic ventricle in the 4thpatient. Mean time from implant to diagnosing the stenosis was 722 days. In all pts the cause of the stenosis was external compression from accumulation of fluid or hematoma between the gore-tex applied at the time of implant and the outflow graft. The stenosis was focal in three and diffuse in one pt. Two of the pts were successfully treated with stenting of the outflow graft and one pt was taken for surgical release of the goretex. In the 4thpt, the stenosis was an incidental finding as we diagnosed acute thrombus ingestion into the inflow cannula which resolved with thrombolytics. All pts experienced an immediate increase in >2L of VAD flow following each, respective, intervention. Conclusion: Outflow graft stenosis in VADs is a serious complication that can lead to decompensated heart failure, the cause of which may be external compression related to gore-tex around the graft. This complication should be included in the differential diagnosis of a drop in VAD flows, and while treatable, should prompt a reassessment of how gore-tex is applied (if at all) at the time of implant.
924 Left Thoracotomy Upper Hemisternotomy Left Ventricular Assist Device (LVAD) Implantation Offers Safe, Durable Option for Patients with Prior Sternotomy Undergoing LVAD Implantation N.M. Foley,1 S. Zalawadiya,2 M. Kuzemchak,1 K. Balsara,1 J. Menachem,2 K. Schlendorf,2 S. Maltais,3 A. Shah,1 and M. Danter.1 1Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN; 2Cardiology, Vanderbilt University Medical Center, Nashville, TN; and the 3Cardiac Surgery, Mayo Clinic, Rochester, MN. Purpose: Increasingly, patients undergoing LVAD implantation have had previous cardiac surgery, and re-operative sternotomy LVAD implantation can pose certain technical challenges. The approval of the thoracotomy approach for LVAD implantation potentially offers increased flexibility of access and may mitigate some of these technical challenges. Thus we reviewed our series of patients with previous sternotomy and who underwent left thoracotomy and upper hemisternotomy LVAD implantation. Methods: Data were compiled on all patients who had consented to be included in the Advanced Heart Failure Registry, at Vanderbilt University Medical Center, between January 2013 and October 2018. Patients who had had previous sternotomy and thoracotomy HeartWareTM HVAD LVAD implantation were included in the analysis. Patients who had undergone thoracotomy HeartMate II (N=3), or off-pump thoracotomy HVAD implantation (N = 9) were excluded from the analysis. The operative technique for all patients involved a limited left anterolateral thoracotomy with an upper hemi-sternotomy anastomosis to the ascending aorta. Preoperative, Intra-operative and post-operative clinical and VAD specific variables were reported. Data regarding clinical end points were analyzed at 30 days and one year following implant.
S368
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
Results: 19 patients satisfied the inclusion criteria, and their characteristics are described in Table 1. One patient died 11 days post LVAD implantation due to multi-system organ failure. This patient was INTERMACS 1 at implant with multi-organ failure pre-operatively. All other patients were either transplanted or still on LVAD support one year following implant. Conclusion: The use of the left thoracotomy upper hemisternotomy approach for LVAD implantation in patients with previous sternotomy is a safe alternative to re-operative sternotomy.
Complete sternal sparing approach compared to reoperative sternotomy Complete Reoperative Sternal-Sparing Sternotomy (n=10) p-value (n=7) Age Male sex BMI INTERMACS 1 Intraoperative Data Cardiopulmonary Bypass Time (min) Delayed closure Outcomes Survived to discharge Overall complications Unplanned return to OR Renal failure requiring dialysis Hepatic failure Severe RV failure Mechanical ventilation time (hr) Intensive Care Unit length of stay (days) Hospital length of stay (days) Thirty-day readmissions
56.1 §11.0 6 (86%) 25.2 §4.6 4 (57%)
64.7 §5.9 9 (90%) 29.7 §6.7 3 (30%)
0.055 1.000 0.146 0.350
151.3 §61.5 5 (71%)
127.7 §24.3 2 (20%)
0.285 0.058
4 (57%) 6 (86%) 2 (29%) 4 (57%) 3 (43%) 4 (57%) 48 [10-96] 14 [4.5-32] 32.5 [20.5-61.5] 0 (0%)
9 (90%) 3 (30%) 1 (10%) 1 (10%) 0 (0%) 0 (0%) 13 [10-42] 4 [3-6] 13 [12-24] 0 (0%)
0.250 0.050 0.537 0.101 0.051 0.015 0.473 0.104 0.218 1.000
926 Concurrent Mitral Valve Repair during Placement of Continuous-Flow Left Ventricular Assist Device M. Cevasco, Y. Naka, A. Saha, A.R. Garan, L. Witer, J. Sanchez, P. Kurlansky, A. Melehy, J. Fried, M. Yusefpolskaya, P. Colombo, H. Takayama and K. Takeda. Columbia University Medical Center, New York, NY.
925 Complete Sternal-Sparing Technique Improves Outcomes and Decreases RV Failure Compared to Re-Operative Sternotomy B.C. Ayers, F. Sagebin, K. Wood, H. Vidula, J. Alexis, B. Barrus, S. Prasad and I. Gosev. University of Rochester, Rochester, NY. Purpose: Patients with a history of previous sternotomy often pose difficult surgical challenges for subsequent cardiac procedures. We hypothesized that the less invasive complete sternal-sparing approach would demonstrate favorable outcomes compared to full sternotomy (FS) for patients with a history of previous sternotomy. Methods: We retrospectively reviewed all patients implanted with a HeartMate 3 (HM3) at our institution from September 2017 through September 2018 (n=63). Patients were included if they had history of prior sternotomy and separated into groups based on LVAD implantation technique: CSS versus re-operative sternotomy. Preoperative characteristics and postoperative outcomes were compared between cohorts. Results: Of the 17 (30%) HM3 patients with a history of previous sternotomy, 10 (59%) were implanted via CSS and 7 (41%) by re-operative sternotomy. The CSS cohort tended to be older (65§6 vs 56§11 years, p = 0.055) and more likely to have undergone CABG (80% vs 14%, p = 0.015) while the FS cohort was more likely to have undergone previous aortic valve replacement (71% vs 10%, p = 0.035) (Table). The CSS cohort demonstrated fewer overall complications (30% vs 86%, p = 0.050) including a decreased incidence of severe right ventricular failure (0% vs 57%, p = 0.015). There was a trend towards shorter ICU length of stay (median, [IQR]; 4 [3-6] vs 14 [4.5-32] days, p = 0.218), total hospital length of stay (13 [12-24] vs 32.5 [20.5-61.5] days, p = 0.104) and improved 30-day survival (90% vs 57%, p = 0.250) in the CSS cohort. Conclusion: LVAD implantation via CSS approach demonstrates fewer complications and decreased incidence of severe right ventricular failure in patients undergoing re-operative cardiac surgery. The CSS approach is our preferred surgical implantation technique for this patient population.
Purpose: Pre-existing mitral valve pathology is common in patients undergoing continuous-flow left ventricular assist device (LVAD) implantation. Best management of pre-existingmitral valve disease remains controversial. Methods: Between March 2004 and December 2017, a total of 594 patients received a continuous-flow left ventricular assist device. Of these, a total of 93 patients (16%) underwent a concurrent mitral valve repair, either with an Alfieri stitch via the left ventricular (LV) apex coring site (n =30, 32%) or with an annuloplasty ring via a left atriotomy (n = 63, 68%). Outcomes were compared between patients who received an Alfieri stitch and those who received an annuloplasty ring repair. Results: All patients had moderate or greater mitral regurgitation at the time of LVAD implantation. Median age was 54 years (interquartile range [IQR], 43-74) in the annuloplasty cohort, and 56 years (interquartile range [IQR], 44-79) in the Alfieri stitch group. A proportionately greater number of women underwent Alfieri stitch repair (n = 6, 20%) compared to ring annuloplasty (n = 5, 8%; p= 0.01). Additionally, a greater number of patients in the Alfieri group underwent a concomitant valve intervention such as a Park stitch or tricuspid repair (n = 15, or 50%) compared to those patients undergoing a ring annuloplasty (n = 28, 44%; p= 0.04). Cardiopulmonary bypass times were shorter on average in the Alfieri patients, independent of concomitant valve procedure (111 minutes versus 134 minutes, p = .02). Thirty-day survival in the Alfieri group (n = 27, 90%) was similar to that of the ring annuloplasty group (n = 57, 91%); p > 0.05. However, in the 84 patients for whom data was available, 1-year survival was higher in the Alfieri group compared to the ring annuloplasty group (26.3% versus 18.6%, p= 0.032). Conclusion: Concomitant mitral valve intervention is fairly common in patients undergoing continuous-flow LVAD placement. Our findings suggest that short-term outcomes are not impacted by type of mitral valve repair technique, but mitral valve repair via the LV apex coring site may be a favorable approach. 927 Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation K. Zhigalov, A. Mashhour, M. Szczechowicz, S. Mkalaluh, J. Ennker, H. Eichstaedt and A. Weymann. Department of Cardiac Surgery, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.