Effect of cardiac arrest with aortic cross-clamping during left ventricular assist device implantation

Masashi Kawabori, Chitaru Kurihara*, Andre Critsinelis, Brendan Pen Haw Chou, Qianzi Zhang, Yuji Kaku, Andrew B. Civitello, Jeffrey A. Morgan

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Some patients who undergo continuous-flow left ventricular assist device (CF-LVAD) implantation require concomitant procedures that can be performed with or without cardiac arrest under aortic cross-clamping (AXC). Procedures normally performed with cardiac arrest are sometimes avoided or performed without cardiac arrest because it may be detrimental to right heart function. However, the effects of cardiac arrest on patients with advanced heart failure necessitating CF-LVAD support have not been thoroughly studied. We examined our single-centre experience to determine whether cardiac arrest during CF-LVAD implantation was associated with worse patient outcomes. METHODS: From November 2003 to March 2016, a total of 526 patients with chronic end-stage heart failure underwent primary CF-LVAD implantation. Preoperative demographics, postoperative complications and mortality rates were compared between patients who required cardiac arrest with AXC (n = 50) and those who did not (n = 476). RESULTS: The most frequently performed procedure requiring AXC was aortic valve closure (n = 23, 26.1%). Although the AXC group had longer cardiopulmonary bypass times (P < 0.01), long-term (5-year) survival was similar in AXC and non-AXC patients (P = 0.13). Also, postoperative right heart failure (P = 0.15) and neurological dysfunction (P = 0.89) rates were not significantly different between the 2 groups. Cox proportional hazards analysis showed that cardiac arrest with AXC was not an independent predictor of mortality (hazard ratio, 0.89; P = 0.73). CONCLUSIONS: Cardiac arrest with AXC during CF-LVAD implantation did not negatively affect long-term survival or the incidence of right ventricular failure or stroke. These findings should be considered in deciding surgical strategies. Additional investigation may be warranted to further understand the effects of cardiac arrest during LVAD implantation.

Original languageEnglish (US)
Pages (from-to)47-53
Number of pages7
JournalInteractive cardiovascular and thoracic surgery
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2020
Externally publishedYes

Keywords

  • Cardiac arrest
  • Concomitant procedures
  • Cross-clamping
  • Left ventricular assist device
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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