Outcomes of expanded polytetrafluoroethylene pericardial membrane
implantation in left ventricular assist device explantation and heart
transplantation
Abstract
Objectives Redo sternotomy and explantation of left ventricular
assist devices (LVAD) for heart transplantation (HT) involve prolonged
dissection, potential injury to mediastinal structures and/or bleeding.
Our study compared a complete expanded polytetrafluoroethylene (ePTFE)
wrap versus minimal or no ePTFE during LVAD implantation, on outcomes of
subsequent HT. Methods Between July 2005 and July 2018, 84
patients underwent a LVAD implant and later underwent HT. Thirty
patients received a complete ePTFE wrap during LVAD implantation (Group
1), and 54 patients received either a sheet of ePTFE placed in the
anterior mediastinum or no ePTFE (Group 2). Results Baseline
characteristics were similar between Groups 1 and 2. Surgeons reported
subjective improvements in speed, predictability and safety of
dissection with complete ePTFE compared with minimal or no ePTFE. Time
from incision to initiation of cardiopulmonary bypass (CPB) were similar
between groups (97±38 min vs 89±29 min, p=0.3). Injury to mediastinal
structures during the dissection was similar between groups (10% vs
11%, p>0.9). While surgeons reported less intraoperative
bleeding in Group 1 (43% vs 61%), this trend did not reach
significance (p=0.1). In-hospital mortality, ICU length of stay and
hospital length of stay were similar between both groups.
Conclusions In patients undergoing LVAD explant-HT, there was a
trend towards reduced surgeon reported intraoperative bleeding with
ePTFE placement. Despite qualitatively reported greater ease and speed
of mediastinal dissection with ePTFE membrane placement, time to
initiation of CPB did not differ, likely because surgeons remained
cautious, allowing extra time for unanticipated difficulties.