Successful outpatient management of patients with ventricular assist devices: A 14 year experience

ment has become an accepted method of extending the life of these patients. An abdominal only approach (AOA) has been used in an effort to minimize the morbidity and mortality for these patients. Methods: From May 2001 to December 2003 fourteen patients required HeartMate LVAD (Thoratec Corporation, Pleasanton, CA) replacements. Eleven (79%) patients were found to be suitable candidates for the abdominal only approach. Results: Ten (91%) procedures were completed using the abdominal only approach, while one (9%) was converted to sternotomy intraoperatively. Perioperative mortality was 10% for AOA replacement. Patients who underwent pump replacement via AOA required less time to recover than they did for their initial implant. The average ICU stay for initial pump placement was 9.6 days, while the ICU stay following AOA pump replacement was 5.9 days, a decrease of 38.5%. The average implant to discharge time for initial implant patients was 25.5 days. The average implant to discharge time following AOA pump replacement was 12.2 days, resulting in a 52.2% decrease. Conclusions: Our single center experience suggests that patients who undergo pump replacement using an abdominal only approach have shorter ICU and implant to discharge durations than they did during their initial pump implant. An abdominal only approach for LVAD replacement should be considered as a viable alternative to sternotomy when possible.