The Journal of Thoracic and Cardiovascular Surgery
Adult: Mechanical Circulatory SupportLess-invasive ventricular assist device implantation: A multicenter study
Graphical abstract
Retrospective analysis of patients with terminal left heart failure who underwent LVAD implantation through the LIS or CS approach. The LIS approach showed shorter hospital length of stay and lower reexploration for bleeding. There was no difference in mortality between LIS and CS.
Section snippets
Materials and Methods
Between January 2014 and December 2018, a total of 342 consecutive patients underwent LVAD implantation for end-stage heart failure at 2 high-volume institutions. The patients at both centers were discussed in detail with the heart failure team. The majority of the surgical cases were performed by 2 surgeons. The decision to proceed with sternotomy or LIS approach (hemi-sternotomy or minithoracotomy approach) was based on the operating surgeon's discretion. Both surgical techniques were used
Results
A total of 342 consecutive patients underwent LVAD implantation (HVAD, HMII, and HMIII) due to end-stage heart failure in both institutions. The LIS approach was performed in 101 patients (29.5%). The LIS approach was feasible in all patients, and none of the patients were converted from LIS to CS. The mean age of patients was 59 ± 11 years. The majority of patients were male (307/342 patients, 90%). Follow-up was complete in 100% of the patients with a total LVAD duration support of 420
Discussion
In this multicenter, propensity-adjusted study comparing VAD implantation with the CS compared with the LIS approach, we illustrated that the LIS approach was associated with a lower reexploration rate for bleeding and shorter duration of hospital stay. In addition, there was no significant difference in cumulative incidence of mortality at final follow-up between these surgical techniques (Figure 2).
Mechanical circulatory support systems are considered an important therapy option for patients
Conclusions
LIS is a safe alternative technique for LVAD implantation. It was associated with a lower reexploration rate for bleeding, shorter intensive care unit length of stay, and shorter length of hospital stay. There was no significant difference in incidence of mortality between these techniques. Randomized trials are necessary to confirm our findings.
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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.
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2022, Journal of Thoracic and Cardiovascular SurgeryLeft 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).
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K.J., F.S., A.L., and D.S. contributed equally.
Presented at the 40th International Society for Heart and Lung Transplant Anniversary Meeting and Scientific Sessions, April 22-25, 2020, Montréal, Canada.