Safe Practices: Partial Coverage of Left Ventricular Assist Device Reduces Bleeding Risk during Explant-Heart Transplant without Causing Obstruction.

Left ventricular assist device (LVAD) explantation is technically challenging during heart transplantation (HT) and is associated with intraoperative and postoperative blood loss. This single institution study examined the effects of partial polytetrafluoroethylene (PTFE) protective coverage during HeartMate 3 implant on perioperative blood loss during the explant-HT. We found that partial PTFE coverage of the outflow graft and chassis during HeartMate 3 implant is significantly associated with reduced intraoperative and postoperative transfusion requirements, and postoperative chest tube output. This association held true after adjusting for prior sternotomies and multi-organ transplants. While previous studies have warned against use of a complete PTFE wrap due to concerns of outflow graft obstruction, our data show that modification to a partial PTFE wrap could mitigate the bleeding risk without increasing the risk of obstruction. Standardization of LVAD implant technique across transplant and non-transplant centers can strengthen continuity of care and facilitate the explant-HT process.