Percutaneous dilatation tracheostomy in patients with left ventricular assist device and established phenprocoumon therapy

Over the last decade the number of heart transplantations declined and the number of implanted left ventricular assist devices (LVAD) markedly increased. Accordingly, common intensive care interventions rise and present their own challenges, especially due to the necessary anticoagulation regimen. One of these procedures is percutaneous dilatation tracheostomy (PDT). We herein report our experience with 34 patients with LVAD and established phrenprocoumon therapy (INR 2.1 ± 0.9, PTT 68.9 ± 19.0 sec.) who underwent PDT between 2006 and 2015 at our specialized cardiac surgery intensive care unit. Intraprocedural success was achieved in all cases (34/34 pts.) with sufficient placement of the tracheal tube and adequate mechanical ventilation. No retained secretions or tracheostomy tube obstructions were observed during follow-up. In no case conversion to surgical tracheostomy was necessary. No serious bleeding complications that required urgent or emergent reoperation occurred during or after the PDT procedure. 16 patients (47.1%) died within the first 30 days after LVAD implantation. This is the first report describing outcomes of patients with LVAD under established phenprocoumon therapy and postoperative implemented PDT. PDT is a safe procedure for those patients. It is not connected with bleeding complications and shows a good procedural outcome.