A COMPARISON BETWEEN INTRAPERITONEAL AND EXTRAPERITONEAL LEFT-VENTRICULAR ASSIST SYSTEM PLACEMENT

The HeartMate left ventricular assist system (LVAS) is being used with increasing frequency as a bridge to heart transplantation and for lon g-term support of chronic heart failure patients who are not transplan t candidates. The surgical techniques and anatomic placement of the He artMate are factors in minimizing complications that occur during long term use. Device related bleeding, infection, and other intraabdominal complications are serious adverse events associated with the position of the LVAS. Clinical data from 48 HeartMate supported patients were analyzed retrospectively to determine differences in serious complicat ion rates between intraperitoneal (IP) and extraperitoneal (EP) LVAS p lacement. The LVAS was placed IP in 37 patients (77%) and EP in 11 pat ients (23%). The occurrence of postoperative bleeding that required re operation was 57% in the IP group and 64% in the EP group. Device rela ted bleeding was 8% in the IP group and 29% in the EP. Neither differe nce in bleeding rate was statistically significant. The overall infect ion rate during the entire period of LVAS support was similar between groups (IP, 45.7%; EP, 46.2%; p = 0.25); however, device related infec tion occurred more often in the EP group (46%; IP, 14%; p = 0.025). Al l patients who recovered from LVAS implantation experienced mild early satiety, but were otherwise free of intra-abdominal complications. Th e transplantation rate was 64% for the IP group and 78% for the EP gro up. IP LVAS placement may offer additional protection against device r elated infections.