Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Corrective Interventional Procedures while on Long-term LVAD Support
P. Lanmüller1, J.-J. Eulert-Grehn1, A. Unbehaun1, C. Klein2, M. Hommel3, M. Kofler1, J. Kempfert1, C. Hörmandinger1, F. Kaufmann1, P. Stawowy2, S. Dreysse2, J. Mulzer1, M. Müller1, V. Falk4, F. Schönrath1, I. A. Just2
1Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin; 2Klinik für Innere Medizin - Kardiologie, Deutsches Herzzentrum Berlin, Berlin; 3Klinik für Kardioanästhesie und Intensivmedizin, Berlin; 4Klinik für kardiovaskuläre Chirurgie, Charité - Universitätsmedizin Berlin, Berlin;
Background: Complications and comorbidities on long-term left ventricular assist device (LVAD) support represent an emerging challenge for caregivers. Due to the substantial risk for open cardiac re-operation, interventional treatment approaches are becoming increasingly important in the LVAD population. 
Methods: We evaluated data of 871 patients who were on LVAD support between January 1st, 2016 and December 1st, 2020. Interventional treatments were performed in 81 patients. 17 patients underwent transcatheter aortic valve replacements (TAVR), 5 patients underwent MitraClip® procedures (MC) and 61 patients underwent outflow graft interventions (OGI).
Results: Interventions were performed in patients with LVAD HeartMate 3, HVAD and HeartMate II (TAVR: n=9, n=8, n=1 patients; MC: n=2, n=1, n=2 patients; OGI: n=4, n=57, n=0 patients, respectively). TAVR improved symptoms in patients with severe symptomatic aortic regurgitation. Trans-stent leaks were more frequently observed in self-expandable valves. Postinterventional complications included aggravation of pre-existing right heart failure (RHF), third-degree atrioventricular block and intrapump thrombosis (in 3 (16.7%), 2 (11.1%) and 1 (5.6%) patients, respectively). Mitral regurgitation was successfully treated by MC as part of our institutional weaning protocol. No complications were observed. In outflow graft obstructions, OGI led to recovery of LVAD flow (3.6 l/min ±1.1 l/min to 4.1 l/min ±0.7 l/min, p<0.001), unloading of the left ventricle (end-diastolic diameter 62.6 mm ±12.8 mm to 59.7 mm ±10.2 mm, p=0.004), decrease of aortic valve opening time (170 ms, IQR 145-185 ms to 155 ms, IQR 120-172 ms, p=0.010) and improvement of right heart function (ejection fraction 41.1% ±12.1% to 45.5% ±8.5%, p<0.001). Complications included bleeding, RHF and others (9 (10.8%), 5 (6.0%), 5 (6.0%) patients, respectively). 8 (9.6%) patients died within the hospital stay after OGI, including mortality secondary to prolonged cardiogenic shock. 
Conclusion: Interventional procedures on LVAD support are a feasible and effective treatment modality to resolve long-term complications and comorbidities. 
 
 C:\Users\donato\Pictures\Grafik_Abstract.jpg

https://dgk.org/kongress_programme/ht2021/P84.htm