Long-term Outcomes in Ventricular Assist Device Outflow Cannula Anastomosis to the Descending Aorta

Abstract Background Left ventricular assist device (LVAD) implantation via thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative implantation technique that uses a single incision and avoids anterior mediastinal planes. We evaluated long-term survival and hospital readmissions following LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta. Methods Adult patients implanted with a continuous flow centrifugal LVAD at an academic center were retrospectively analyzed. Patients were assigned to one of the two cohorts based on the anastomosis site of the LVAD outflow cannula: ascending aorta cohort (Asc–Ao) and descending aorta cohort (Desc–Ao). Primary and secondary outcomes were survival and hospital readmissions during device support. Readmission analysis included patients with ≥30-day survival following discharge. Multivariable analysis and propensity score matching were performed. Results Survival analysis included 330 patients (Asc–Ao: 272, Desc–Ao: 58). Readmission analysis included 277 patients (Asc–Ao: 231, Desc–Ao: 46) and a total of 1028 readmissions during 654 patient-years of follow-up were analyzed. There was no significant difference in in–hospital, 6–month, 1–year, 3–year and 5–year mortality between the two cohorts. Readmission–free survival, 30–day readmission, number of admissions per year and hospital length of stay per year were not significantly different between the 2 cohorts following adjustment for patient characteristics. Conclusions This study found no difference in long-term survival or hospital readmissions between LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta and standard implantation.