Preoperative AF was associated with a similar incidence of postoperative stroke, device thrombosis, and survival. On the basis of these data, it seems unnecessary to perform a left atrial appendage ligation or to alter postoperative anticoagulation in patients with AF undergoing LVAD implantation.

These data indicate excellent survival for BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become a plausible alternative to heart transplantation, we need to further decrease the incidence of postoperative complications.

The purpose of our study was to evaluate outcomes in patients with hepatic fibrosis at the time of LVAD implantation. There were five (2.1%) patients with preoperative hepatic fibrosis with a mean age of 51.2 ± 16.8 years. Survival at 180 days was significantly reduced in patients with hepatic fibrosis, 40.0% vs. 88.0%; p = 0.001. Hepatic fibrosis was a significant independent predictor of mortality in multivariate analysis (hazard ratio [HR] 2.27, p = 0.036).

The incidence of pump thrombosis was also similar-4.2% vs. 3.7%%; p= 0.999. Survival was similar between the groups with 1-month, 6-month, 1-year, and 2-year survivals of 100.0%, 100.0%, 94.7%, and 94.7%, respectively, for DL infection patients, versus 93.5%, 85.8%, 79.6%, and 69.8%, respectively, for patients without DL infections (p= 0.259). DL infection was not a significant predictor of survival in Cox proportional hazard regression (HR 1.58, p= 0.277). Conclusion: Drive line infections were not associated with a higher incidence of thromboembolic complications. Based on these data, it does not appear necessary to raise anticoagulation target goals in the setting of a DL infection.

Purpose: We reviewed our nine year experience of continuous flow left ventricular assist devices (LVADs) to determine the impact of preoperative atrial fibrillation (AF) on stroke, device thrombosis, and survival. Methods: Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs -127 (52.9%) as bridge to transplant (BTT) and 113 (47.1%) as destination therapy (DT). Effect of AF on postoperative outcomes was assessed by using Kaplan Meier survival and Cox proportional hazard regression. Results: There were 78 (32.5%) patients with preoperative AF with a mean age of 55.7 + 11.4 years. There was a similar incidence of stroke in patients with and without AF -12.8% versus 16.0%, respectively (p= 0.803). The incidence of device exchange for thrombosis was also similar in both groups (3.9% vs. 3.7%; p= 0.999). Survival was similar, with 1-month, 6-month, 12-month, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF patients, versus 93.1%, 85.0%, 79.4%, and 74.1%, respectively, for non-AF patients (p= 0.424). Preoperative AF was not a significant independent predictor of survival using Cox proportional hazard regression (HR 1.08, 95% CI 0.66-1.76). Conclusion: Preoperative AF was associated with a similar incidence of postoperative stroke, device thrombosis, and survival. Based on these data, it seems unnecessary to perform a left atrial appendage ligation or alter postoperative anticoagulation in patients with AF undergoing LVAD implantation.