Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience

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 -