Impact of Left Atrial Appendage Occlusion on Thromboembolic Complications in Patients Supported by the Heartmate II Left Ventricular Assist Device

Abstract

Abstracts S129 Results: Figure shows representative waveforms of pump speed, AoP, and pump flow with sinusoidal pump speed modulations of 0%, ±15% and ±25%. The AoP pulse pressure significantly increased to 12.7 mm Hg and 17.7 mmHg with ±15% and ±25% speed modulations, respectively (Table). There were no changes in the mean AoP, mean pump flow, or left atrial pressure. Conclusion: The feasibility to generate pressure pulsatility by pump speed modulation with the CFTAH was validated. This unique platform is suitable for evaluating the physiologic impact of pulsatility and allows determination of the best speed modulations in term of magnitude, frequency, and profiles. ( 329)Purpose: Thromboembolic complications (TEC) are a major adverse event for VAD patients. Occlusion of the left atrial appendage (LAA) reduces TEC in patients with atrial fibrillation (AF). AF burden increases following VAD placement and is associated with worse outcomes. It is unknown whether LAA occlusion (LAAO) at the time of VAD implantation is beneficial. Methods: We performed a retrospective analysis of patients receiving the HeartMate II VAD at our center. TEC were defined as a sustained (> 2 separate measurements) elevation (2.5x upper reference range) in LDH requiring intensified anticoagulation; stroke; pump thrombosis or device exchange; or death due to thrombotic event. Blood pressure and outpatient anticoagulation management were standardized. Event rates for TEC were compared between the cohort treated with and without LAAO using Poisson regression. Results: Of 42 patients undergoing VAD implant (mean age 65.5 years, 81% male), 15 (36%) had concomitant LAAO [14 AtriClip, 1 TIGERPAW System II] at the discretion of the implanting surgeon. AF was present preoperatively in 7/15 (47%) of the LAAO patients vs 14/27 (52%) not receiving LAAO. In the LAAO cohort, there was 1 peri-operative stroke. In the cohort without LAAO, TEC were significantly more frequent: 6 patients had at least one episode of LDH elevation; 4 patients had a total of 6 strokes; 4 patients had pump exchanges for thrombosis; and there were 4 deaths due to pump thrombosis. The rate of TEC was significantly lower in the LAAO group S130 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 ...