Thorac Cardiovasc Surg 2016; 64 - ePP90
DOI: 10.1055/s-0036-1571749

Less Invasive LVAD Surgery in Cardiogenic Shock

S. V. Rojas 1, M. Avsar 1, J. S. Hanke 1, E. Deniz 1, M. Hillert 1, K. Tümler 1, C. Kühn 1, A. Martens 1, G. Warnecke 1, M. Shrestha 1, S. Cebotari 1, A. Haverich 1, J. D. Schmitto 1
  • 1Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany

Objectives: LVADs are gaining more importance in the treatment of terminal heart failure. In cardiogenic shock, LVAD implantation is considered as rescue therapy with high mortality and complication rates. In this context, less invasive implantation techniques might contribute to improve surgical outcomes. Therefore we investigated the outcome of cardiogenic shock patients in our institution that underwent LVAD implantation by less invasive surgery.

Methods: We reviewed the data of 32 consecutive patients that received veno-arterial ECMO support prior to LVAD implantation in our institution between 2012 and 2014. Patients were divided into two groups: Group A (full sternotomy, n = 18) and Group B (Less invasive, n = 14). Less invasive surgery was defined by upper hemisternotomy and anterolateral thoracotomy. All patients underwent LVAD implantation (HVAD, Heartwire) on pump.

Results: Demographical data: 71.4% male, age (y) 52.1 ± 13.1, BMI (kg/m2): 26.6 ± 5.1, previous cardiac surgery: 35.7%, preoperative ECMO 100% preoperative ECMO time (d): 3.8 ± 2.9, LVEF 16.0 ± 4.0%. Intra- and postoperative data (Group A vs. Group B): postoperative ECMO: 61.1 versus 50.0% (p = 0.48), days on postoperative ECMO: 4.8 ± 5.7 versus 3.5 ± 5.6 (p = 0.51), postoperative bleeding: 38.9 versus 14.2% (p = 0.19), pericardial tamponade: 28.6 versus 0% (p < 0.05), mean ICU stay (d): 23.6 ± 20.0 versus 18.2 ± 12.9 (p = 0.35). 30-day survival: 50.0 versus 64.3% (p = 0.41), 1-year survival: 44.1 versus 57.1% (p = 0.47). None of the patients showed a pump thrombosis or further bleeding events in the follow-up period.

Conclusion: Cardiogenic shock is a risk factor for outcome in LVAD-implantation. Preoperative ECMO-treatment is well-suited as bridge to LVAD-therapy. Compared with the existing literature with 180-day mortality rates up to 60 to 70%, our results show a tendency to improved outcomes. Moreover, patients who underwent less invasive LVAD implantation showed less surgical complications with enhanced survival rates.