Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience
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Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience. / Reichart, D; Brand, C F; Bernhardt, A M; Schmidt, S; Schaefer, A; Blankenberg, S; Reichenspurner, H; Wagner, F M; Deuse, T; Barten, M J.
in: THORAC CARDIOV SURG, Jahrgang 67, Nr. 3, 04.2019, S. 170-175.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience
AU - Reichart, D
AU - Brand, C F
AU - Bernhardt, A M
AU - Schmidt, S
AU - Schaefer, A
AU - Blankenberg, S
AU - Reichenspurner, H
AU - Wagner, F M
AU - Deuse, T
AU - Barten, M J
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2019/4
Y1 - 2019/4
N2 - BACKGROUND: Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group).METHODS: HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed.RESULTS: No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48).CONCLUSION: The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.
AB - BACKGROUND: Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group).METHODS: HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed.RESULTS: No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48).CONCLUSION: The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.
KW - Adult
KW - Aged
KW - Female
KW - Germany
KW - Heart Failure/diagnosis
KW - Heart-Assist Devices
KW - Humans
KW - Male
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures
KW - Postoperative Complications/etiology
KW - Prosthesis Design
KW - Prosthesis Implantation/adverse effects
KW - Recovery of Function
KW - Retrospective Studies
KW - Sternotomy/adverse effects
KW - Thoracotomy/adverse effects
KW - Time Factors
KW - Treatment Outcome
KW - Ventricular Function, Left
U2 - 10.1055/s-0038-1649493
DO - 10.1055/s-0038-1649493
M3 - SCORING: Journal article
C2 - 29804285
VL - 67
SP - 170
EP - 175
JO - THORAC CARDIOV SURG
JF - THORAC CARDIOV SURG
SN - 0171-6425
IS - 3
ER -