Outcomes of midterm circulatory support by left ventricular assist device implantation with descending aortic anastomosis

For some patients undergoing left ventricular assist device (LVAD) implantation, the perfusion tube is anastomosed to the descending aorta instead of the currently more prevalently used ascending aorta. Purpose of this study was to assess retrospectively the outcomes of LVAD patients with descending aortic anastomosis. Between March 2007 and March 2010, six patients underwent LVAD implantation with descending aortic anastomosis with Toyobo or Jarvik 2000 LVAD at our institute. Their average circulatory support time was 434 (range 82-751) days. Both types of LVAD afforded adequate circulatory support, and inotrope treatment and mechanical ventilation were discontinued relatively early. Echocardiograms of the three patients with Jarvik 2000 LVAD revealed antegrade flow in the ascending aorta during the intermittent low-speed period. Among them, one patient developed infarction in the right brain hemisphere because of thromboembolism, whereas another patient developed pneumonia in the left lung followed by a lethal systemic infection. One patient on Toyobo LVAD support reached heart transplantation without morbidity. Another patient implanted with Toyobo LVAD, whose left ventricular function was too poor to generate forward flow through aortic valve, developed thrombus in the ascending aorta. No embolic events were observed in the organs below the diaphragm. In conclusion, descending aortic anastomosis of the perfusion tube can be used for LVAD implantation for some patients, but considerable risks of morbidities, including thromboembolic events and/or infection, should be recognized.