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LV Unloading with Continuous-Flow Left Ventricular Assist Devices: The Association Between Left Ventricular Size and Late Survival
Abstracts 476 Home INR Monitoring: Does It Help Reduce the Chance of Re-Admission for LVAD Patients? J. Han,1 N. Nahumi,1 M. Yuzefpolskaya,1 R. Te-Frey,2 A.R. Garan,1 M.-F.R. Torres,1 H. Takayama,2 P.C. Colombo,1 Y. Naka,2 U.P. Jorde,1 N. Uriel.1 1Medicine Columbia University, New York, NY; 2 Surgery, Columbia University, New York, NY. Purpose: Anticoagulation therapy in Continuous Flow (CF) Left Ventricular Assist Device (LVAD) pts continues to be challenging due to high frequency of Gastrointestinal (GI) bleeding and device thrombosis. This study sought to determine if using a Home INR Machine (HINRM) will reduce the risk of these complications. Methods and Materials: All pts monitored by HINRM during LVAD support were enrolled. Data on anticoagulation regimen and device related complications were collected. Results: 14 CF-LVAD pts who have used or currently use HINRM were identified. Mean age was 68 ⫾ 11 years old, 86% were male and 57% were destination therapy. 86% (n¼12) were compliant and their INR was maintained within therapeutic range 67⫾24% of the time. The INR values were reported on average once every 9.2 ⫾ 5.3 days. While not using HINRM (386⫾367 days), 43% (n¼6) of these pts were readmitted for GI bleeding (4 pts), device thrombosis (1 pt) and epistaxis (1 pt). While using HINRM (376⫾250 days), 21% (n¼3) of these pts were readmitted for 3 cases of GI bleeding, 1 case of epistaxis and none from DT. Two of the GI bleeding cases occurred during a 3month period of non-compliance from a single pt. The total event rate was reduced from 0.41 to 0.28 events/person-year, respectively.
S179 Results: Of 247 continuous-flow LVADs implanted from June 2006 to August 2012, echocardiographic data was available for 215 patients. This cohort included 37 females and 178 males, with an average age of 55þ/-14 years. Indications for LVAD implantation was 161 patients bridge to transplant, 85 were destination therapy, and one patient was a bridge to recovery. Mean LVEDD at LVAD implant was 6.53þ/1.23 cm. LVEDD was not associated with survival (HR 2.01, 95% CI 0.45 – 9.0, P¼0.36), however as depicted in Figure 1, a trend towards improved survival is seen in those with LVEDD of 5 cm when compared with LVEDD of 4 6 cm.
Conclusions: The current study does not find a correlation between LVEDD and survival, however further investigation with a larger F1 study is required to rule out type II error. 478 Conclusions: Our data suggests that self-monitoring with HINRM among CF-LVAD pts is a feasible form of maintaining adequate INR range with good compliance. Lower readmission rate for GI bleeding and device thrombosis was noted after using HINRM than prior. F1 Larger cohorts with longer follow up times are warranted.: 477 LV Unloading with Continuous-Flow Left Ventricular Assist Devices: The Association Between Left Ventricular Size and Late Survival A.D. Nagpal,1 N. Moazami,1 D. Kalavrouziotis,1 M.Z. Tong,1 K.J. Hoercher,1 S. Lee.2 1Cardiothoracic Surgery Cleveland Clinic Foundation, Cleveland; 2Cardiology, Cleveland Clinic Foundation, Clevaland. Purpose: Left ventricular assist device (LVAD) therapy for the failing ventricle dramatically improves survival, but the nuances of optimal ventricular unloading remain unknown. Ideally, clinicians would titrate LVAD speed using an easily attainable metric that reflects LV unloading and correlates well with an important outcome such as death. We sought to determine if left ventricular end-diastolic dimension (LVEDD) meets these ideal criteria. Methods and Materials: A retrospective review of all patients receiving a continuous-flow LVAD at a single center was undertaken. Patients who underwent an echocardiogram at our institution and had LVEDD recorded in the database were included. Simple descriptive statistics were employed, and survival was modeled using Kaplan-Meier analysis. A Cox proportional hazards model with LVEDD as a time-dependent covariate was used to produce hazard ratio estimates.
Outcomes of Minimally Invasive vs. Conventional Implantation of Continuous Flow Left Ventricualr Assist Device: A Single Center Experience M. Toma,1 J. Bashir,2 A. Kaan,3 S.S. Cowan,1 A. Cheung,2 S. Virani.1 1 Department of Medicine Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada; 2Department of Surgery, Division of Cardiovascular Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada; 3Department of Nursing, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada. Purpose: The use of left ventricular assist device (LVAD) as a bridge to transplant and for destination therapy is increasing. Conventional LVAD implantation (CON) is performed using a midline sternotomy. In some centers, LVADs are implanted with a minimally invasive surgical (MIS) approach using a mini-thoracotomy. However, little data exists comparing outcomes of these two techniques. Methods and Materials: All Heartware continuous flow LVADS (HVAD) implanted at our institution were included in this analysis. We assessed the baseline characteristics and in-hospital as well as long terms outcomes (using INTERMACS definitions) in those who had CON vs. MIS implantation. Results: Between May 2010 and Sept 2012, 40 HVADs were implanted. Of those, 15 (37%) were MIS and 25 (63%) were CON. Median length of support censored at time of transplantation was 149 days for MIS and 181 days for CON. The average age in the MIS group was lower than the CON group (48 vs. 57, p ¼ 0.04), but other baseline characteristics were similar between the MIS and CON groups: male sex 60% vs 76%,
S179 Results: Of 247 continuous-flow LVADs implanted from June 2006 to August 2012, echocardiographic data was available for 215 patients. This cohort included 37 females and 178 males, with an average age of 55þ/-14 years. Indications for LVAD implantation was 161 patients bridge to transplant, 85 were destination therapy, and one patient was a bridge to recovery. Mean LVEDD at LVAD implant was 6.53þ/1.23 cm. LVEDD was not associated with survival (HR 2.01, 95% CI 0.45 – 9.0, P¼0.36), however as depicted in Figure 1, a trend towards improved survival is seen in those with LVEDD of 5 cm when compared with LVEDD of 4 6 cm.
Conclusions: The current study does not find a correlation between LVEDD and survival, however further investigation with a larger F1 study is required to rule out type II error. 478 Conclusions: Our data suggests that self-monitoring with HINRM among CF-LVAD pts is a feasible form of maintaining adequate INR range with good compliance. Lower readmission rate for GI bleeding and device thrombosis was noted after using HINRM than prior. F1 Larger cohorts with longer follow up times are warranted.: 477 LV Unloading with Continuous-Flow Left Ventricular Assist Devices: The Association Between Left Ventricular Size and Late Survival A.D. Nagpal,1 N. Moazami,1 D. Kalavrouziotis,1 M.Z. Tong,1 K.J. Hoercher,1 S. Lee.2 1Cardiothoracic Surgery Cleveland Clinic Foundation, Cleveland; 2Cardiology, Cleveland Clinic Foundation, Clevaland. Purpose: Left ventricular assist device (LVAD) therapy for the failing ventricle dramatically improves survival, but the nuances of optimal ventricular unloading remain unknown. Ideally, clinicians would titrate LVAD speed using an easily attainable metric that reflects LV unloading and correlates well with an important outcome such as death. We sought to determine if left ventricular end-diastolic dimension (LVEDD) meets these ideal criteria. Methods and Materials: A retrospective review of all patients receiving a continuous-flow LVAD at a single center was undertaken. Patients who underwent an echocardiogram at our institution and had LVEDD recorded in the database were included. Simple descriptive statistics were employed, and survival was modeled using Kaplan-Meier analysis. A Cox proportional hazards model with LVEDD as a time-dependent covariate was used to produce hazard ratio estimates.
Outcomes of Minimally Invasive vs. Conventional Implantation of Continuous Flow Left Ventricualr Assist Device: A Single Center Experience M. Toma,1 J. Bashir,2 A. Kaan,3 S.S. Cowan,1 A. Cheung,2 S. Virani.1 1 Department of Medicine Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada; 2Department of Surgery, Division of Cardiovascular Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada; 3Department of Nursing, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada. Purpose: The use of left ventricular assist device (LVAD) as a bridge to transplant and for destination therapy is increasing. Conventional LVAD implantation (CON) is performed using a midline sternotomy. In some centers, LVADs are implanted with a minimally invasive surgical (MIS) approach using a mini-thoracotomy. However, little data exists comparing outcomes of these two techniques. Methods and Materials: All Heartware continuous flow LVADS (HVAD) implanted at our institution were included in this analysis. We assessed the baseline characteristics and in-hospital as well as long terms outcomes (using INTERMACS definitions) in those who had CON vs. MIS implantation. Results: Between May 2010 and Sept 2012, 40 HVADs were implanted. Of those, 15 (37%) were MIS and 25 (63%) were CON. Median length of support censored at time of transplantation was 149 days for MIS and 181 days for CON. The average age in the MIS group was lower than the CON group (48 vs. 57, p ¼ 0.04), but other baseline characteristics were similar between the MIS and CON groups: male sex 60% vs 76%,