Retention of left ventricular assist device outflow grafts after transplantation

Abstract

Background: New sternum-preserving techniques are increasingly being utilized for implantation of left ventricular assist devices (LVADs) in bridge-to-transplant patients. During device explantation for transplantation through median sternotomy, the outflow graft is divided where convenient, which generally results in retention of a significant blind limb of outflow graft attached to the descending thoracic or supraceliac aorta. Although the retained graft could be completely excised through a repeat thoracotomy, we decided to investigate the short- and long-term complications related to retained grafts and whether they outweigh the risk of additional surgery.

Methods: We reviewed the charts and computed tomography (CT) scans of 18 patients who underwent successful bridge to cardiac transplantation between January 2003 and August 2006, and in whom the initial LVAD implant was performed via a sternum-sparing procedure. In each case, a blind graft limb was retained at the time of device explantation.

Results: An LVAD was implanted either through a left sub-costal incision (6 patients) or through a left thoracotomy (12 patients). Patients were supported for an average of 113 days while awaiting transplantation (13 to 299 days). Four patients died of causes not directly related to the retained graft. Mean observation time of the remaining 14 patients was 53.6 months (21.6 to 76.9 months). There was no evidence of distal emboli, pseudoaneurysm or graft infection in any patient.

Conclusions: The presence of a retained graft limb after LVAD removal for transplantation is associated with few complications. For patients in whom removal of the graft would require additional surgery, oversewing the graft and leaving it in place is a reasonable strategy.