Complexities of Explanting Durable LVADs (Done at Outside Facilities) at the Time of Heart Transplant Surgery.

Patients with severe heart disease may require hemodynamic support with a durable left ventricular assist device (LVAD) as a bridge to heart transplantation (HTx). Techniques to implant these durable LVADs do vary from institution to institution. Use of various materials to separate tissues also vary amongst implanting institutions. When these patients move to another facility, explanting these LVADs may be more problematic when undergoing HTx. It is not known whether explantation of an LVAD performed at another institution is fraught with more complications. Between January 2010 and June 2021, we evaluated 176 patients who had durable LVAD explanted at the time of HTx. Patients were separated into those that had durable LVAD performed at our transplant hospital versus those that were placed at an outside facility. The following endpoints were obtained: number of blood products administered, primary graft dysfunction, vasoplegia, intraoperative vascular complications, time in the operating room (OR), and 30-day post-HTx survival. Durable LVADs placed at an outside facility compared to those placed internally led to a trend in increased intraoperative complications during HTx surgery. However, there was no significant difference in blood products used, OR time, primary graft dysfunction, vasoplegia, and 30-day survival between the 2 study groups. Durable LVADs placed at an outside institution poses an increased risk for peri-operative complications when bridging to HTx. Extra time should be afforded to compensate for these potential problems. [ABSTRACT FROM AUTHOR]