Finding a proper “Mate”: Comparison of left ventricular assist devices using cerebral oximetry

Abstract

Introduction:

Axial-flow and centrifugal-flow left ventricular assist devices (LVAD) have been utilized in the management of heart failure, but it remains unknown whether these devices differ in end-organ perfusion. Our goal was to evaluate the association between device type and regional cerebral oxygen saturation (rSO₂), and determine if this confers any benefit in short-term postoperative outcomes.

Methods:

Adult patients who underwent primary LVAD implantation at our institution from 2014 to 2019 were retrospectively analyzed. Patients were stratified into axial-flow and centrifugal-flow groups. Intraoperative rSO₂ readings were used to calculate the change in mean rSO₂ from pre- to post-bypass. Multivariable modeling was performed to compare delta rSO₂ between groups, and to analyze the association between LVAD type and postoperative outcomes.

Results:

There were 152 patients included, of which 76 had an axial-flow device and 76 had a centrifugal-flow device implanted. The rSO₂ level increased from pre-bypass to post-bypass on average 3.5% (CI: 2.1 to 5.0) for the axial group compared to 0.1% (CI: −1.2 to 1.4) for the centrifugal group, which was a significant difference (β = −2.22, CI: −4.21 to −0.32, p = 0.022). Axial devices approached significance for lower odds of postoperative complications (OR: 0.35, CI: 0.11 to 1.06, p = 0.063), and were associated with significantly shorter ICU LOS (β = −0.36, CI: −0.60 to −0.11, p = 0.004).

Conclusion:

Axial devices resulted in a greater increase in rSO₂ than centrifugal pumps after separation from CPB. Further investigation is warranted to evaluate the effect of LVAD selection on long-term end-organ perfusion and subsequent patient outcomes.

Keywords

Cardiac assist and artificial heart ventricular assist devices artificial kidney apheresis and detoxification techniques VAD axial flow congestive heart failure cardiac surgery cardiopulmonary bypass

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