groups we confirmed that results are optimal when elective LVAD

implantation is performed before development of inotropic depen-

dency or cardiogenic shock. These results suggest that age need not be

a limiting factor in the decision to implant MCS in end stage heart

failure.

792

Temporary RVAD Support after LVAD – Longterm OutcomeC.C.O. Oezpeker, M.M.S. Schoenbrodt, S.S.E. Ensminger,J.J.G. Gummert, M.M.M. Morshuis. Department of Thoracic andCardiovascular Surgery, Heart- and Diabetes Center NRW, RuhrUniversity Bochum, Bad Oeynhausen, North-Rhine Westphalia,Germany.

Purpose: Right heart failure after LVAD implantation can still be a

significant problem in patients with moderate reduced right ventricular

function. The aim of this study was to analyse the outcome of 42

patients with temporary centrimac RVAD support.

Methods and Materials: From September 2004 until March 2012 281

LVADs were implanted at our center. Out of this cohort, 42 patients

14.9 % (gender: male n ¼33; female n¼9 Age: 53.6 � 13.8 years)

needed temporary RVAD support with Centrimag. The mean

supporting time was 36.2 days (min. 1 / max. 183 days). The following

LVADs were used in this patient cohort: HW (18), HMII (16), DH (2),

Ventras (2), Novacor (2), HeartAs (1) and CorAid (1). Cannulation

was performed via right atrium/ pulmonary artery (22), pulmonary

artery / femoral vein (14) and femoral artery/vein (4). In 27 patients an

Oxygenator was also required. Clinical outcomes of the patients

were assessed with respect to survival, successful weaning and major

complications such as bleeding or ischemia and neurological events

were analysed.

Results: Out of 42 patients, 8 patients were weaned successfully and

discharged home. 5 patients initially successfully weaned expired

during follow up as a consequence of complications such as sepsis and

MOF under LVAD support. In addition, 4 patients were directly

bridged to heart transplantation. However, in 3 patients weaning was

not possible and these were bridged to longterm RVAD- HeartWare

(1) and TT (2) support. 22 patients expired under combined LVAD/

RVAD support. Reason for death included MOF (10), MOF and

sepsis (7), sepsis (1) and intracerebral bleeding (4). Additional pro-

blems were acute abdominal complications requiring surgery (3) and

one leg ischemia.

Conclusions: These data suggest that even patients suffering RV failure

after LVAD support can nowadays have an acceptable longterm

outcome.

793

Prolonged Mechanical Circulatory Support – 1000 Days with a LeftVentricular Assist DeviceC. Oezpeker, S. Oemer, M. Schoenbrodt, K. Hakim, L. Kizner,J. Boergermann, H. Milting, S. Ensminger, J. Gummert, M. Morshuis.Clinic for Thoracic and Cardiovascular Surgery, Ruhr-UniversityBochum, Heart & Diabetescenter NRW, Bad Oeynhausen, Germany.

Purpose: Ventricular assist devices (LVADs) are used for bridge to

heart transplantation (BTR) and long term destination therapy (DT)

for patients with end stage heart failure. Due to the growing number of

patients with terminal heart failure and a decrease in suitable donor

organs, timespans on mechanical circulatory support (MCS) of

patients are continuously increasing.

Methods and Materials: Since 2006 283 patients received LVAD

support with HeartMate II (HM2; n¼160), Duraheart (DUH; n¼74)

and Ventrassist (VA; n¼46). We analysed 34 patients (12.01%) who

were supported with a device for more than 1000 days. The patients

were divided into two groups, DT (n¼11: VA n¼5, HM2 n¼4, DUH

n¼2) and BTR (n¼22: HM2 n¼9; VA n¼7; DUH n¼6). Patients were

analysed retrospectively with regard to neurologic, infectious and

gastrointestinal complications.

Results: Mean duration of support of all patients was 1278 days. 7 out

of 34 patients, were succesfully transplanted, 4 died and 1 was

successfully weaned and 22 patients are still on support. Major

complications during support were driveline infections (n¼7), gastro-

intestinal bleedings (n¼7), technical failure (n¼6/cable breakage n¼4),

neurologic events (n¼6). First hospitilization after inital discharge

home was after 9.8 months, the mean frequency of hospitilizations

being 4.1 times. The overall mean duration of hospital stay was 65

days. Reasons for high urgency transplantation were neurologic

complications (n¼3; TIA,intracerebral bleeding, stroke), cable break-

age (n¼3) and hemolysis (n¼1). Five patients expired (min. 1063days/

max. 1392days) under support because of malignant tumors (n¼2), late

right heart failure (n¼1), intracerebral bleeding (n¼1) and one patient

becuase of primary graft failure post heart transplantation.

Conclusions: In the light of substantial donor organ shortage and the

growing number of heart failure patients prolonged MCS has become

a more frequent treatment modality. Here we show that this can be

achieved with acceptable longterm results.

794

Biopsy Proven Liver Fibrosis and Outcomes in Patients Supported with aContinuous-Flow Left Ventricular Assist DeviceS. Lee,1 M. Halkar,2 D. Nagpal,3 M. Bennett,1 N.N. Zein,4

N. Moazami,3 R.C. Starling.1 1Section of Heart Failure and CardiacTransplant Medicine, Cleveland Clinic, Cleveland, OH; 2InternalMedicine, Cleveland Clinic, Cleveland, OH; 3Cardiothoracic Surgery,Cleveland Clinic, Cleveland, OH; 4Digestive Disease Institute, ClevelandClinic, Cleveland, OH.

Purpose: It is not clear whether patients with biopsy proven liver

fibrosis have worse outcomes following continuous-flow left ventri-

cular assist device (CF LVAD) implantation.

Methods and Materials: We retrospectively reviewed all patients in our

institution that had a liver biopsy prior to implantation of a CF

LVAD. Continuous variables were analyzed with Student’s T-test and

categorical variables were analyzed with Fischer’s Exact test.

Results: From June 2006 to August 2012, there were 14 patients that

had a liver biopsy prior to CF LVAD implant. The mean age of

patients was 55�10 years, 87% were male, and 47% had ischemic

cardiomyopathy. Indications for CF LVAD implant were destination

therapy (n¼5; 36%), bridge to transplant (n¼8; 57%) and bridge to

decision (n¼1; 7%). The patients were divided into two groups: those

with liver fibrosis grade 0 to 1 (Group A, n¼5) and those with liver

fibrosis grade41 (Group B, n¼9). Baseline demographics were similar

between the two groups. There were no significant differences in post-

operative renal failure requiring dialysis (p40.99), reoperation for

bleeding (p¼0.36), requirement of inotropes414 days post LVAD

implant (p¼0.5) or post operative hospital length of stay (LOS)

(p¼0.72). No patients in either group required RVAD implantation.

Post LVAD implant survival was 100% in both groups at 30 days and

was 100% and 78% at 1 year for group A and B respectively (p¼0.5).

Conclusions: In this single center retrospective review, patients with liver

biopsy proven4 stage 1 fibrosis have similar outcomes in terms of short

and mid-term survival, need for dialysis, reoperation for bleeding, post-

operative inotrope requirement and LOS compared to those with zero

or low grade liver fibrosis. No patients in either group required RVAD

support. These findings may have important implications in the selection

of LVAD candidates with liver dysfunction.

795

Home Discharge and Out-of-Hospital Follow-Up of Total Artificial HeartPatients Supported by a Portable DriverA. El Banayosy,1 M. Morshius,2 M. Slepian,3 L. Arusoglu,3

J. Gummert.3 1Heart and Vascular Institute, Penn State HersheyMedical Center, Hershey, PA; 2Cardiology, University of Arizona,Tucson, AZ; 3Cardiac Surgery, Heart Center NRW, Bad Oeynhausen,Germany.

Purpose: To enhance ambulation and facilitate hospital discharge of

TAH-supported patients we adapted a mobile ventricular assistance

device (VAD) driver (ExcorTM) for TAH use and report on the

performance of ExcorTM– driven TAH patients discharged home.

Abstracts S285