Coagulopathic profile in patients undergoing left ventricular assist device (LVAD) implantation is associated with hemorrhagic complications. We are using plasma exchange (PE) in these patients prior to surgery to improve their outcomes.
We reviewed data of 56 consecutive patients who received an LVAD at our institution. Twenty-five patients had PE prior to the implant on the day of surgery, while 31 did not. PE consisted of a one plasma volume using FFP for replacement.
Except for age (56±12 years in PE group vs.48±14 years in controls, P=0.024), the groups were comparable in gender, body weight, NYHA class, requirement of an intra-aortic balloon pump, cardiac index, creatinine, bilirubin, hemoglobin, PT, INR, PTT and platelet count. Duration of CPB, blood loss and transfusion requirements were similar between groups. In the PE group, none of 25 patients expired in the initial postoperative period of 7 days while 6 of 31 patients died in control group, P=0.028. Available data regarding inflammatory state of the patients with preoperative PE show 70% decrease in concentrations of proinflammatory cytokine interleukin-6 (IL-6) after PE.
It appears that preoperative PE leads to improved perioperative survival in patients undergoing LVAD implantation. Mechanism of action probably includes modulation of inflammatory state in these patients.