Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure

Objective: Although the development of continuous-flow ventricular assist devices (CF-VAD) has improved the reliability of these devices, VAD exchange is still occasionally necessary. The focus of this study was to analyze our institution's entire experience with primary CF-VAD implants, evaluate the baseline variables, determine which factors predict the need for exchange, and evaluate the impact of exchange on survival and event-free survival. Methods: We retrospectively reviewed the data of all patients in a single center who received a primary CF-VAD implant between December 1999 and December 2013. All CF-VAD exchanges were reviewed; demographics, indications, preoperative and operative data, and clinical outcomes were summarized. Univariate and multivariable regression analyses were performed to ascertain predictors for exchange. Time-to-event and survival analyses were also performed. Results: We identified 469 patients who underwent 546 CF-VAD implantations. Of these patients, 66 (14%) underwent 77 exchanges from one CF-VAD to another. The primary indications included hemolysis or thrombosis (n = 49; 63.6%), infection (n = 9; 11.7%), or other causes (n = 19; 24.7%). Survival was not significantly different between the exchange and nonexchange groups. Multivariable regression analysis identified a history of cerebrovascular events as a significant predictor for exchange. Among exchange patients, 11 underwent heart transplantation, 3 had their CF-VADs explanted, 26 had ongoing support, and 26 died during device support. Conclusions: In our series of contemporary CF-VAD exchanges, a history of previous cerebrovascular events was a significant predictor for exchange. Exchange did not affect early or late survival. Our data suggest that aggressive surgical treatment of pump-related complications with exchange is safe and justified.