Premium
Minimally Invasive Implantation of Continuous Flow Left Ventricular Assist Devices: The Evolution of Surgical Techniques in a Single‐Center Experience
Author(s) -
Carrozzini Massimiliano,
Bejko Jonida,
Guariento Alvise,
Rubino Maurizio,
Bianco Roberto,
Tarzia Vincenzo,
Gregori Dario,
Bottio Tomaso,
Gerosa Gino
Publication year - 2019
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13339
Subject(s) - medicine , thoracotomy , ventricular assist device , surgery , median sternotomy , anastomosis , implant , ischemic cardiomyopathy , cardiology , heart failure , ejection fraction
In this work we aimed to evaluate the evolution of our surgical experience with the implantation of a continuous flow left ventricular assist device (LVAD), from the original full sternotomy approach to less invasive surgical strategies including mini‐sternotomy and/or mini‐thoracotomies. We reviewed all consecutive patients implanted with a continuous flow LVAD at our Institute. To exclude the possible bias related to the device used, out of 91 collected LVADs implants, we selected only those patients ( n = 42) who received, between 2012 and 2015, the HeartWare HVAD. The analysis focused on the surgical approach used for the LVAD implant. Most of the patients (95%) were affected by dilated or ischemic cardiomyopathy, with an INTERMACS class I‐II in the majority of cases (77%). The LVAD implant was performed through a full sternotomy in 10 patients (24%); the remaining 32 cases (76%) were managed with minimally invasive procedures. These were left mini‐thoracotomy with upper mini‐sternotomy (20 patients, 62%), right and left mini‐thoracotomy (7 patients, 22%), and a recently developed left mini‐thoracotomy with outflow graft anastomosis to the left axillary artery (5 patients, 16%). The most common adverse event on device was right heart failure (26%). Eighteen patients (43%) were transplanted. Overall estimated 24 months survival (on device or after transplant) was 68 ± 7%. The causal analysis, adjusted by propensity score weighting baseline data and sample size, showed that left mini‐thoracotomy with outflow anastomosis to the left axillary artery resulted in a significantly reduced rate of post implant right heart failure ( P < 0.01), and mechanical ventilation time ( P = 0.049). To conclude, in our series, by applying mini‐invasive implant techniques in the majority of cases, mid‐term survival of continuous flow LVADs in severely compromised patients was satisfactory. In the adjusted analysis, the left anterior mini‐thoracotomy with outflow anastomosis to the left axillary artery showed the most favorable results.