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Combined Left Ventricular Assist Device and Coronary Artery Bypass Grafting Surgery

Should We Bypass the Bypass?

Mehta, Priya*; Imamura, Teruhiko; Juricek, Colleen; Sarswat, Nitasha; Kim, Gene; Raikhelkar, Jayant; Song, Tae; Ota, Takeyoshi; Jeevanandam, Valluvan; Sayer, Gabriel; Uriel, Nir

doi: 10.1097/MAT.0000000000000956
Original Article: PDF Only

Left ventricular assist devices (LVADs) have become a mainstay of therapy for advanced heart failure. Although selected patients undergo concomitant coronary artery bypass grafting (CABG) at the time of LVAD implantation, the detailed implication of this combined surgical approach is not yet well studied. In this study, all ischemic cardiomyopathy patients who underwent concomitant CABG during LVAD implantation between 2010 and 2016 were enrolled. A control group matching for age, gender, and device type, were selected. Of 79 LVAD patients finally included, 28 patients underwent concomitant CABG (CABG group); whereas 51 did not (non-CABG group). There was no difference in the baseline characteristics between groups. There was a trend toward longer cardiopulmonary bypass time in the CABG group (169 vs. 147 min; p = 0.09). One month survival in the CABG group was significantly lower than the non-CABG group (75.0% vs. 94.1%; p = 0.014). No difference in the occurrence of ventricular arrhythmias was detected between the groups, nor was there a difference in the incidence or severity of right ventricular failure. Concomitant CABG surgery during LVAD implantation may carry significant perioperative mortality, and addition of CABG to LVAD surgery may be performed only in strictly selected cases.

From the *Internal Medicine Residency Program, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois

Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois

Section of Cardiothoracic Surgery, University of Chicago Medical Center, Chicago, Illinois.

Submitted for consideration June 2018; accepted for publication in revised form October 2018.

Disclosure: The authors have no conflicts of interest to report.

Teruhiko Imamura receives financial funding from Postdoctoral Fellowship for Research Abroad of Japan Society for the Promotion of Science. Nir Uriel receives consultant fee and grants support from Abbott and Medtronic; Gabriel Sayer receives consultant fees from Medtronic; and Valluvan Jeevanandam receives consultant fee from Abbott.

Priya Mehta and Teruhiko Imamura contributed equally to this article.

Correspondence: Nir Uriel, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue Chicago, IL 60637. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs