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Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.
- Source :
-
JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2020 Sep; Vol. 6 (9), pp. 1131-1139. Date of Electronic Publication: 2020 Aug 26. - Publication Year :
- 2020
-
Abstract
- Objectives: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD.<br />Background: Many patients with a left ventricular assist device (LVAD) will require implantable cardioverter-defibrillator generator change or device revision or are candidates for de novo implantable cardioverter-defibrillator implantation following LVAD implantation.<br />Methods: We performed an observational retrospective study of all LVAD recipients who subsequently underwent CIED surgery at Duke University Hospital from 2009 to 2019.<br />Results: A total of 159 patients underwent CIED surgery following LVAD implantation, including generator change (n = 93), device revision (n = 38), and de novo implant (n = 28). The median (interquartile range) time from LVAD implantation to CIED surgery was 18.1 months (5.5 to 35.1 months). Pre-operative risk for infection was elevated in the overall cohort with a median (interquartile range) Prevention of Arrhythmia Device Infection Trial (PADIT) score of 7.0 (5.0 to 9.0). Pocket hematoma occurred in 21 patients (13.2%) following CIED surgery. Antimicrobial envelops were used in 43 patients (27%). Device infection due to CIED surgery occurred in 5 (3.1%) patients and occurred only in patients who developed post-operative pocket hematoma (p < 0.001). Mortality at 1 year following CIED surgery was 20% (n = 32).<br />Conclusions: CIED surgery following LVAD implantation is associated with an increased risk for pocket hematoma and CIED infection. Further studies are needed to determine the risk-benefit ratio of CIED surgery in patients with LVADs.<br /> (Copyright © 2020 American College of Cardiology Foundation. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 2405-5018
- Volume :
- 6
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- JACC. Clinical electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 32972548
- Full Text :
- https://doi.org/10.1016/j.jacep.2020.04.030