Thorac Cardiovasc Surg 2015; 63 - OP46
DOI: 10.1055/s-0035-1544298

Minimally Invasive LVAD Surgery in Septuagenarians

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

Objectives: LVAD therapy for destination patients is becoming more frequent in the past years since demographical changes and improved medical therapy induce an aging population with congestive heart failure. Thus, in the context of poor donor organ availability there is a growing demand for alternative surgical options for these patients. Common LVAD implantation is associated with complications like bleeding, right heart failure and high mortality. This especially applies for older patients. Less invasive LVAD surgery has shown to improve postoperative outcome in adults. The aim of our study was to assess the early outcome of patients with severe heart failure receiving an LVAD as destination therapy.

Methods: We reviewed the 1 year-outcome of 11 end-stage heart failure patients who underwent less invasive LVAD implantation (HVAD, HeartWare, USA) in our institution between 2012 and 2013. All the procedures were performed on pump including an upper hemisternotomy with a left sided thoracotomy. Patients with concomitant surgical procedures were excluded.

Results: Demographical data: 100% male, age 71,4 ± 1,3y, DCM 54,5%, ICM 45,5%, previous cardiac surgery: 45,5%, cardiac index 1,6 ± 0,6 l/min/BSA, LVEF 20,5 ± 8,5%, INTERMACS 2,7 ± 1,1. Survival after 30 days and in the 1-year-follow up was 100%. 45,5% of patients required extended inotropic support, one patient needed surgery due to postoperative bleeding, three patients were on dialysis postoperatively, mean ICU stay was 11,6 ± 8,6d, postoperative Bilirubin-levels: 34,6 ± 19,9 µmol/l, pump flow: 5,3 ± 0,8l/min at 2990 ± 150U/min, pHb: 42,3 ± 23,9mg/l, LDH: 485,9 ± 180U/l. There was no incidence of stroke or gastrointestinal bleeding during intrahospital stay. One of the patients developed epistaxis after six months on device.

Conclusions: Our data indicate that LVAD implantation in septuagenarians for destination therapy shows promising early and mid-term outcome with 100% survival 1 year after surgery. Because of this small patient cohort, higher amounts of patients are needed to investigate potential benefits of this novel method.