ORIGINAL CLINICAL SCIENCEImplantation of a fully magnetically levitated left ventricular assist device using a sternal-sparing surgical technique
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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Cited by (34)
Less is better? Comparing effects of median sternotomy and thoracotomy surgical approaches for left ventricular assist device implantation on postoperative outcomes and valvulopathy
2024, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :RHF is a major cause of morbidity and mortality after LVAD implantation, occurring in 10% to 40% of cases.24 A recent multicenter study by Saeed and colleagues6 demonstrated decreased incidence of RHF after less-invasive LVAD implantation compared with MS. Previous studies have also shown a decreased in RV failure associated with less-invasive implantation techniques.25-27 Although the mechanism of this protective effect is not fully understood, it is hypothesized to be related to the preservation of the pericardium, which helps maintain normal RV geometry, limit dilatation, and, in allowing the heart to remain in its native anatomic position, reduce the risk of RV free-wall tethering and hypoperfusion.6,27,28
A novel intrapericardial pulsatile device for individualized, biventricular circulatory support without direct blood contact
2023, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Indeed, after LVAD implantation, the average length of stay in the intensive care unit is approximately 9 to 11 days and the median time in hospital ranges between 20 and 40 days. In the context of current LVADs, less-invasive implantation strategies were found to significantly reduce these postoperative lengths of stay and where associated with further improved recovery.35-37 The average implantation time in our study was around 15 to 30 minutes, which is expected to translate to even shorter postoperative stays in an intensive care unit.
Less-invasive ventricular assist device implantation: A multicenter study
2022, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Complete closure of pericardium over the aorta was feasible in all cases. Our results are similar to the results of Gosev and colleagues.14 They conducted an unmatched single-center study of 105 total patients comparing HeartMate III implantation using LIS versus CS.
Left ventricular assist device implantation via lateral thoracotomy: A systematic review and meta-analysis
2022, Journal of Heart and Lung TransplantationCitation Excerpt :However, even in these studies full sternotomy was used more commonly in the early years and lateral thoracotomy more commonly in later years. Five studies1,3,20,21,23 were multicenter and eight studies11,18-23,27 reported propensity matched or adjusted data for 1,195 patients (410 lateral thoracotomy and 785 sternotomy patients; Table 1). The HeartWare HVAD (Medtronic Inc., USA) was the most commonly implanted device (n = 2,090 [68%]), followed by the HeartMate 3 (n = 622 [20%], HeartMate II (n = 239 [8%]; Abbott, USA), and Jarvik 2000 (n = 93 [3%]; Jarvik Heart, USA).
Anesthetic Considerations for Minimally Invasive, Off-Pump, HeartMate III Implantation
2022, Journal of Cardiothoracic and Vascular AnesthesiaTrends and Outcomes of Left Ventricular Assist Device Therapy: JACC Focus Seminar
2022, Journal of the American College of Cardiology