Abstracts S253

Overall, 21 patients (77.8%) were successfully treated medically, 5 (18.5%) 6( 89)

underwent pump exchange and 1 (3.7%) died. The average time from admis-
Impact of Reduced Antiplatelet Therapy on Early Hematologic Adverse
sion to discharge, exchange, or death was 9 days. Six patients had a bleed
Events During Heart Mate II Support
requiring transfusion. There were no differences in outcomes or complica-
O. Saeed , V. Alapati, A. Luke, A. Delaconcha, S. Murthy, J. Shin, D. Sims,
tions between the 3 groups. The six month survival in the patients treated
S. Patel, D. Goldstein, U. Jorde. Medicine, Albert Einstein College of
medically was 90% and surgically was 60%.
Medicine Montefiore Medical Center, Bronx, NY.
Conclusion: Our experience indicates that medical therapy for suspected
LVAD thrombosis with warfarin and integrilin alone or in combination with
Purpose: Retrospective studies show that high dose aspirin (ASA) during
argatroban or heparin appears safe and may be effective for the management
Heart Mate (HM) II support is associated with more hemorrhagic events;
of hemolysis or pump thrombosis. integrillin should be considered as part of
however, limited prospective data exist on the impact of switching to reduced
the medical therapy for hemolysis and pump thrombosis.
antiplatelet therapy.
Methods: We implemented a clinical protocol to place all patients with HM
6( 88)
II implantation (n= 26) from November 2014 to September 2015 on low
ABO Blood Group and Bleeding Post-LVAD dose aspirin (ASA) 81 mg daily. Concomitant anticoagulation with warfarin
R.T. Cole , D. Gupta, J. Lee, J. Gandhi, C. Lambert, Y. Garcia-Bengochea, (target INR: 2-2.5) was maintained. Adverse events (AEs) were compared to
P. Sandesara, M. Yin, A. Smith, S. Laskar, A. Morris. Cardiology, Emory a historical cohort of HM II patients (n= 69) on high dose ASA 325 mg daily
Univ Sch of Med, Atlanta, GA. and warfarin therapy (target INR: 2-3). Excluding perioperative events, initial
hemorrhagic (gastrointestinal, intracranial, epistaxis), thrombotic (ischemic
Purpose: ABO blood group is a major determinant of plasma von Willebrand stroke, surgically confirmed pump thrombosis) and hemolysis (LDH > 2.5x
Factor (vWF) levels, and O blood type patients have 25% lower levels com- upper limit of normal) events were retrieved up to 100 days after implanta-
pared to non-O groups. Patients treated with continuous flow LVADs are tion. GI bleeding was defined by requiring a blood transfusion and a drop in
known to develop an acquired vWF deficiency and are therefore at risk for hemoglobin of > 2g/dL. Survival free from AEs was calculated by Kaplan-
bleeding events. It is unclear if the risk of bleeding in these patients is affected Meier curves.
by ABO blood group. We hypothesized that O blood type patients have higher Results: Patients in both groups had similar distributions of major demo-
bleeding rates compared to non-O blood type patients following cfLVAD. graphics including age, gender and history of hypertension. The actual INR
Methods: Retrospective review of 114 consecutive cfLVAD patients at our was similar across groups throughout HM II support. Hemorrhagic events
center from July 1, 2006 to July 1, 2013. Clinical, ECHO, demographic, occurred in only 3 patients on ASA 81 mg daily (12%, 0.17 events/100d)
and lab (including ABO) variables analyzed by univariate and multivariable in comparison to 30 patients on ASA 325 (43%, 0.64 events/100d, p= 0.02,
cox regression to determine those associated with bleeding risk post-LVAD. figure 1). Thrombotic events occurred in 2 patients on ASA 81 mg (8%,
Bleeding events were defined as any bleed requiring an ED visit, hospitaliza- 0.1 events/100d) and in 4 patients on ASA 325 mg (6%; 0.07 events/100d,
tion, or transfusion. p= 0.70). Hemolysis occurred in 2 patients on ASA 81 daily (8%, 0.1
Results: After a mean followup of 677 days, 50/114 (44%) patients had at events/100d) and in 4 patients on ASA 325 mg daily (6%; 0.07 events/100d,
total of 115 bleeding events. There were 0.58 EPPY in the O blood group p= 0.75).
compared to 0.77 EPPY in the non-O (p= 0.399). Univariate analysis showed Conclusion: Low dose ASA in HM II patients treated concomitantly with
a trend towards less bleeding in the O blood group (p= 0.127). In a multivari- warfarin is associated with a reduced risk of bleeding without increased
able cox model incorporating age > 65, gender, and CHF etiology, there was thrombotic and hemolysis events.
no difference in bleeding by blood group and a trend towards less bleeding
in the O blood group (HR 0.73, CI 0.41-1.30, p 0.28).
Conclusion: Despite the recognition that O blood type is associated with
lower cWF at baseline, O blood type was not associated with higher rates
of bleeding events. In fact, there was a trend toward less bleeding in the O
blood group compared to non-O.

6( 90)
New Method to Route the Driveline of Implantable Left Ventricular
Assisted Device for Prevention from Driveline Infection
S. Yoshitake , K. Nawata, O. Kinoshita, Y. Hoshino, Y. Itoda, A. Yamamoto,
M. Kimura, H. Yamauchi, M. Ono. Cardiac Surgery, Tokyo University
Hospital, Tokyo, Japan.

Purpose: The Left Ventricular Assisted Device (LVAD) related infections

remain an Achilles heel of long-term LVAD therapy as it leads to significant
morbidity and mortality. Among these infections, the most prevalent and
important is driveline infection (DLI). Several reports showed that longer
driveline route would be helpful to prevent DLI. From 2014, we employed
 the revised surgical technique that included longer subfascial driveline route.
Methods: There were 85 patients who received LVAD implantation as a
bridge to transplantation in the University of Tokyo Hospital from 2007
to June 2015. Among them, we retrospectively analysed 33 cases of axial
pumps, which are HeartMate II (n=22) and Jarvik 2000 (n=11). Before 2014,
the driveline proceeded from the pump pocket just above the posterior sheath
of rectus muscle to exit through the vertical skin incision at a lateral border
of the rectus muscle. And then the driveline was folded and tunneled into