A Novel Paradigm: Application of Extracorporeal Transvalvular Axial-Flow Pumps to Support Advanced Heart Failure Patients Undergoing Abdominal Surgery.

Over 10 million major non-cardiac surgeries are performed yearly with a continuing and parallel increase of HF prevalence in the general population and the need to perform abdominal surgery (AS). Patients with advanced HF present severe mortality risk during AS. Heart transplant (HT) and AS guidelines consider the presence of multiple pathologies as contraindication for surgical treatment and the dual severity of these conditions has halted adequate therapy for patients with advanced HF. Transvalvular axial-flow pumps (TVAFP) provide hemodynamic stability and support patients with advanced HF receiving AS. The authors herein present the initial experience with AS in patients with decompensated HF under TVAFP support. A retrospective review of patients undergoing AS under TVAFP was conducted. Basic demographics, type of AS, time on support, transition to other supportive devices, outcomes, and mortality rates are reported. Four patients received AS while supported with TVAFP. The patients were predominantly male (75%) with an age, body mass index, and cardiac index average of 36.8±17.8 years, 37.9±11.3 kg/m2, and 1.7±0.2 L/min/m2, respectively. The average time and discontinuance of TVAFP support was 4±22.5 days following insertion. Length of stay, total weight loss and BMI at last encounter averages were 50.5±29.5 days, 60.5±32.4 lbs., and 30.6 kg/m2, respectively. All patients were discharged home alive, with 2 patients receiving HT during index admission, and 2 patients listed for HT within 3 months of AS. The average time from TVAFP support to HT listing, performance of HT, and follow-up after HT, were 118.8±118.9 days, 239±163, and 225±99.5 days, respectively. The combined surgical approach employing TVAFP hemodynamic support during AS represents a safe, and effective strategy for advanced HF patients. Further studies are necessary to confirm these initial observations. [ABSTRACT FROM AUTHOR]