Clinical Outcomes of Left Ventricular Assist Device Implantation for Patients Refusing Blood Transfusion

• Published in: The Journal of heart and lung transplantation Vol. 39; no. 4; p. S427
• Main Authors: Koda, Y., Nishida, H., Kagan, V., Meehan, K., Okray, J., Creighton, S., Labuhn, C., Nguyen, A., Kalantari, S., Chung, B., Kim, G., Sarswat, N., Smith, B., Grinstein, J., Onsager, D., Song, T., Jeevanandam, V., Ota, T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2020
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2020.01.216

Left ventricular assist device (LVAD) implantation for patients refusing blood transfusion presents a distinct challenge. This study summarizes our center's experience in clinical outcomes of LVAD implantation for patients who refuse blood transfusion.
The cohort included 21 Jehovah's Witness (JW) patients who underwent an LVAD implantation between 2008-2019. Non-JW patients (N=427) served as a control. We previously established the perioperative optimization protocol for JW patients. The protocol includes preoperative optimization of hemoglobin (Hb) level with a goal of >12 g/dl using iron, vitamin B12, and erythropoietin. There are also protocolized intraoperative techniques and postoperative management to minimize blood loss.
Hb levels in eight patients (38.1%) were successfully optimized (as defined by Hb>12g/dl) before surgery in the JW group. In-hospital mortality was 14.3% (3/21) in the JW group, and 11.7% (50/427) in the non- JW group (p=0.35). One-year survival was similar between in the JW group and the non- JW group (79.3±9.3% vs. 68.1±2.4%, p=0.43). Causes of mortality during the follow-up period in the JW group included stroke (N=4), right-sided heart failure (N=2), device thrombosis, sepsis, gastrointestinal bleeding (GIB), and unknown (N=1), respectively. Freedom from GIB at 1 year was 83.9± 8.5% in the JW group and 74.9±2.4% in the non-JW group (Log-Rank p=0.95). Overall, 5 patients suffered from GIB during follow up in the JW group. Three of them required esophagogastroduodenoscopy or endovascular catheterization to obtain hemostasis with medical therapy including intravenous iron, erythropoietin, and octreotide.
The clinical outcomes of LVAD implantation for patients refusing blood transfusion were comparable to those who accepted blood transfusions. LVAD therapy for such a patient population is feasible in select patients and is facilitated with the use of perioperative optimization protocols.