Perioperative Blood Product Use: A Comparison Between HeartWare and HeartMate II Devices

Haglund, Nicholas; Davis, Mary E.; Tricarico, Nicole M.; Ahmad, Rashid; DiSalvo, Thomas G.; Keebler, Mary; Schlendorf, Kelly; Wigger, M.; Stulak, John M.; Maltais, Simon

doi:10.1016/j.athoracsur.2014.05.016

Cited by 18 publications

(20 citation statements)

References 25 publications

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“…We have previously detailed that LVAD patients generally drain over 3 L through their chest tubes in early recovery from LVAD implantation, 90% of which occurs in the first several days. 6 This is a critical time when chest tubes have a high potential to clot and impair drainage. 7,8 This led us to form the hypothesis that the high volume of early bleeding combined with a potentially high rate of chest tube clogging may contribute to the elevated need for reinterventions for retained blood in this population.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 After presentation of options, a multidisciplinary committee tailored an informed decision to patient and physician preferences for device and incision selection. 6 Delayed sternal closure was used primarily when bleeding risk was perceived to be elevated and occasionally when moderate to severe postoperative right ventricular (RV) dysfunction caused hemodynamic deterioration.…”

Section: Methodsmentioning

confidence: 99%

“…1–3 It is not uncommon for patients to require reinterventions for retained blood, such as re-exploration to wash out clot from the mediastinum, delayed primary closures of the sternum, or require additional chest tube placement to drain hemothorax. 1,4–6 These patients have increased complications, significantly higher overall mortality and worse 1 year survival after transplantation making this an area with significant unmet clinical needs for process improvement. 1,4,5 …”

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confidence: 99%

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Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

et al. 2016

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Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43–15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34–6%, p <0.001). In a sub-analysis of CS only, there continued to be statistically significant 53% reduction in re-exploration (45% vs. 21%, p = 0.0011), and a 77% reduction in DSC (35% vs. 8%, p < 0.001) in group 2. Using a logistic regression model adjusting for CS versus MILT, there was a significant reduction in re-exploration (odds ratio [OR] = 0.44 [confidence interval {CI} = 0.23–0.85], p = 0.014) and DSC (OR = 0.20 [CI = 0.08–0.46], p <0.001) in group 2. Actively maintaining chest tube patency after LVAD implantation significantly reduces re-exploration and DSC.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

et al. 2016

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“…15 In addition, our group has previously demonstrated reduced blood product utilization and shorter operative times in HW recipients compared with the HM-II. 16 Specific device differences related to pump mechanics 8,17 and effects on the coagulation system 9 are also emerging. We found that patients who had multiple readmissions were more frequently HM-II recipients and that multiple readmissions comprised the majority of overall readmissions (87%).…”

Section: Does Device Type Matter?mentioning

confidence: 99%

Readmissions After Continuous Flow Left Ventricular Assist Device Implantation

et al. 2015

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Readmissions after continuous flow left ventricular assist devices implantation are common. We compared the frequency and etiology of readmissions between two continuous flow left ventricular assist devices 6 months after implant. We retrospectively assessed readmissions in 81 patients who received a bridge to transplant HeartMate-II (HM-II) n = 35, 43% or HeartWare (HW) n = 46, 57%, from 2009 to 2014. Readmissions were divided into cardiac, infection, gastrointestinal bleeding, stroke, pump thrombosis, and miscellaneous profiles. Age, gender, creatinine, INTERMACS profiles were comparable between groups (p > 0.05). Sixty-one patients accounted for 141 readmissions. At 6 months, the overall readmission rate was higher among HM-II versus HW recipients (2.3 ± 1.7 vs. 1.4 ± 1.3; p = 0.024). Multiple readmissions (≥2) occurred more frequently in HM-II recipients (HM-II 23, 66% vs. HW 20, 44%; p = 0.047) which accounted for 87% of overall readmission frequency. Cardiac profile was the most common reason for readmission (HM-II = 15, HW = 17; p = 0.95). Readmission for arrhythmia (HM-II = 10, HW = 3; p = 0.021) and overall infection rate (0.49 ± 0.70 vs. 0.17 ± 0.68; p = 0.001) were more common among HM-II recipients; however, other readmission profiles were comparable between devices (p > 0.05). Readmission frequency, multiple readmissions, and clinical profile characteristics were different between HM-II and HW recipients.

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“…1 Blood transfusion with cardiac surgery has been associated with increased risk of sepsis, stroke, 2-5 right ventricle dysfunction, 6 mortality, 2,4,7-9 higher cost of care, 3 and immune modulation. 10 The latter is particularly important for patients awaiting heart transplantation (HTx) where allo-sensitization would lead to prolonged wait times and possibly graft failure.…”

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confidence: 99%

Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data

et al. 2016

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Blood transfusion rates with cardiac surgery over time have decreased, this trend has not been examined for patients undergoing left ventricular assist device (LVAD) implantation. We investigated blood transfusion trends with LVAD implantation in a statewide database. Between July 2004 and June 2014, 666 LVADs were implanted (age 54.5 ± 12.6 years. 77% men). Reoperation for bleeding was required in 22% of cases. Postoperative mortality was 13.2%. Over the decade, use of any blood products with LVAD surgery by year ranged from 83% to 100% (92 ± 5.3%). Intraoperative and postoperative blood products use was 71.8% and 73%, respectively. Only 7.4% of patients did not receive any blood products. Blood transfusion during surgery consisted of plasma (60%), platelets (56%), red blood cells (RBCs) (44.3%), and cryoprecipitate (32%), whereas after surgery RBC use was more frequent (68%). Compared with the initial 5 years (2005-2009), the units of blood transfused in the second 5 years (2010-2014) were significantly less, 21 ± 23 units vs. 16.6 ± 20.5 units, p = 0.0038. By multivariable analysis, preoperative factors predictive of blood transfusion are lower hematocrit, lower BMI, reoperative surgery, requirement for intraaortic balloon pump (IABP), and nonelective surgery. Blood transfusion with LVAD implantation remains very high. However, the amount of blood product transfused has decreased in the last 5 years.

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Perioperative Blood Product Use: A Comparison Between HeartWare and HeartMate II Devices

Cited by 18 publications

References 25 publications

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

Readmissions After Continuous Flow Left Ventricular Assist Device Implantation

Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data

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