ORIGINAL CLINICAL SCIENCE
Implantation of a fully magnetically levitated left ventricular assist device using a sternal-sparing surgical technique

https://doi.org/10.1016/j.healun.2019.09.012Get rights and content

Background

Left ventricular assist devices (LVADs) have improved outcomes for selected patients with advanced heart failure, but alternative optimal surgical techniques remain to be defined. We aim to describe our initial experience in using a sternal-sparing (SS) technique for implantation of a magnetically levitated LVAD, the HeartMate 3 (HM3) pump.

Methods

This retrospective, single-center study included consecutive patients implanted with the HM3 LVAD between September 2015 and September 2018. Patients were compared based on surgical approach: SS or traditional sternotomy (TS). The primary outcome was overall survival at 6 months. Secondary outcomes included peri-operative complications, blood product utilization, and hospital readmissions.

Results

Of 105 patients implanted with the HM3 LVAD, 41 (39%) were implanted via SS and 64 (61%) via TS approach. There were no intraoperative conversions. The SS patients were younger; otherwise, all other characteristics were similar between cohorts. The SS cohort demonstrated a significantly lower incidence of severe right ventricular failure (7% vs 28%, p = 0.012), fewer blood-product transfusions (41% vs 86%, p < 0.001), and shorter index hospital length of stay (15.5 vs 21 days, p = 0.018). Six-month survival was 93% for the SS cohort.

Conclusions

In this single-center observational study, we have demonstrated that the SS approach may be a safe and effective surgical technique for implantation of the HM3 LVAD in well-selected patients. The potential benefits compared with TS require further inquiry.

Section snippets

Patient population

We performed a retrospective analysis of prospectively collected data in our institutional Ventricular Assist Device Database. All patients implanted with the HM3 (Abbott, Chicago, IL) LVAD at our institution from September 2015 through September 2018 were included. There were no cases of emergency or compassionate use HM3 implantation. Since the first SS patient, there have been 4 HeartWare (HVAD, Medtronic, Minneapolis, MN) implants and no primary HeartMate II (HMII, Abbott) implantations.

Patient characteristics

A total of 105 patients were implanted with the HM3 LVAD between September 2015 and September 2018. The SS technique was used for 64 (61%) patients, and 41 (39%) patients were implanted using TS. The median age of the study cohort was 60 years, with the SS patients being significantly younger (57 vs 61 years, p = 0.015). Both cohorts consisted of critically ill patients, including a high proportion of INTERMACS profile 1 (41% SS vs 34% TS, p = 0.497). VA ECMO was used in 22% of SS and 13% of TS

Discussion

This consecutive series includes 105 patients implanted with the HM3 LVAD at our institution between September 2015 and September 2018. We demonstrate similar 6-month survival in both surgical technique groups, either SS or TS, when adjusted for age, severity of disease, and therapeutic intent. Our findings suggest that the SS approach is associated with a low incidence of severe RV failure, decreased blood product transfusions, earlier extubation, and a shorter hospital LOS with well-preserved

Disclosure statement

Igor Gosev is a consultant for Abbott. Sunil Prasad is on the scientific advisory board for Abbott.

The authors thank all members of our interdisciplinary heart failure team for their support and contribution to this project.

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