3:27 PM Abstract No. 330 Descriptive analysis of patients with left ventricular assist devices undergoing image-guided procedures

Left ventricular assist devices (LVAD) are mechanical therapies for end-stage heart failure that require anticoagulation and are associated with high rates of complications including third spacing, bleeding, and thromboembolic events. Minimally invasive image-guided procedures can be invaluable in managing LVAD patients who are not typically considered surgical candidates. This study describes our institution’s procedural experience with LVAD patients in interventional radiology (IR). We reviewed a retrospective database of LVAD procedures performed in an academic medical center from 2010-2018. Demographics, preprocedural labs, complications, and outcomes data were collected from electronic health records. Descriptive statistics were calculated on both a patient- and encounter-level as many patients in the dataset underwent multiple image-guided procedures. Categorical variables are presented as frequencies with percentages. 67 LVAD patients underwent 109 image-guided procedures during the study period. Based on SIR guidelines, 65 (59.6%) procedures were category 2 bleeding risk and 44 (40.4%) were category 1. The most common procedures performed were chest tube placement (n = 43, 39.4%), thoracentesis (n = 12, 11%), and embolization (n = 12, 11%). Patients were therapeutically anticoagulated (preprocedural aPTT>70 and/or INR>2) for 67 (61.5%) procedures. Intraprocedural blood loss of >50 mL occurred in 2 (1.8%) cases. Postprocedural bleeding occurred in 15 (13.8%) cases, and 38 (34.9%) cases received transfusions within 30 days. Of 12 (11.0%) total complications, 3 patients had major complications requiring further intervention or contributed to clinical deterioration. Eight (11.9%) patients died within 30 days of a procedure; causes of death were determined to be unrelated to the procedure itself or were multifactorial in etiology. While performing image-guided minimally invasive procedures on the LVAD patient population is not without risk, they are sometimes necessary and can be performed if benefits are deemed to outweigh risks.