Anelechi C Anyanwu1, Shinobu Itagaki2, Sean Pinney3, David H Adams2. 1. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY, USA anelechi.anyanwu@mountsinai.org anianyanwu@hotmail.com. 2. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY, USA. 3. Transplant Cardiology, Mount Sinai Medical Center, New York, NY, USA.
Abstract
OBJECTIVES: Standard implantation of HeartMate II (HMII) left ventricular assist device requires an extended median sternotomy; this incision, while generally well tolerated, may add morbidity in critically ill debilitated patients. We recently adopted a sternum sparing technique for routine HMII implants using a left subcostal incision to create a pocket and access the left ventricular apex, and a right minithoracotomy to access the ascending aorta. METHODS: Retrospective analysis of 40 consecutive patients (M:F 32 : 8; age range 48-77 years; Interagency Registry for Mechanically Assisted Circulatory Support 1 = 8; 2 = 10; 3 or 4 = 22) who underwent implantation of HMII using a non-sternotomy approach in a single institution. RESULTS: HMII insertion was completed with the less invasive technique in all cases with no conversions to full sternotomy. There were no reoperations for bleeding and 70% of patients did not have any intraoperative blood product transfusion. No patient required right ventricular assist device support. Majority of patients (80%) were extubated by postoperative day 1. There were no wound, mediastinal or pocket infections. One patient suffered a new perioperative stroke. Median postoperative hospital stay was 19 days. Operative mortality was 7.5% and 12-month actuarial survival was 86 ± 6%. CONCLUSIONS: Primary HMII implantation without median sternotomy is feasible and can be safely, effectively and routinely applied, using our less invasive approach. Further investigation is necessary to determine whether the non-invasive technique contributed to the low incidence of bleeding, blood transfusion, respiratory morbidity and right ventricular failure seen in this study.
OBJECTIVES: Standard implantation of HeartMate II (HMII) left ventricular assist device requires an extended median sternotomy; this incision, while generally well tolerated, may add morbidity in critically ill debilitated patients. We recently adopted a sternum sparing technique for routine HMII implants using a left subcostal incision to create a pocket and access the left ventricular apex, and a right minithoracotomy to access the ascending aorta. METHODS: Retrospective analysis of 40 consecutive patients (M:F 32 : 8; age range 48-77 years; Interagency Registry for Mechanically Assisted Circulatory Support 1 = 8; 2 = 10; 3 or 4 = 22) who underwent implantation of HMII using a non-sternotomy approach in a single institution. RESULTS: HMII insertion was completed with the less invasive technique in all cases with no conversions to full sternotomy. There were no reoperations for bleeding and 70% of patients did not have any intraoperative blood product transfusion. No patient required right ventricular assist device support. Majority of patients (80%) were extubated by postoperative day 1. There were no wound, mediastinal or pocket infections. One patient suffered a new perioperative stroke. Median postoperative hospital stay was 19 days. Operative mortality was 7.5% and 12-month actuarial survival was 86 ± 6%. CONCLUSIONS: Primary HMII implantation without median sternotomy is feasible and can be safely, effectively and routinely applied, using our less invasive approach. Further investigation is necessary to determine whether the non-invasive technique contributed to the low incidence of bleeding, blood transfusion, respiratory morbidity and right ventricular failure seen in this study.
Authors: Supriya Shore; Michael J Pienta; Tessa M F Watt; Gardner Yost; Whitney A Townsend; Lourdes Cabrera; Michael D Fetters; Carol Chenoweth; Keith D Aaronson; Francis D Pagani; Donald S Likosky Journal: J Heart Lung Transplant Date: 2021-10-22 Impact factor: 13.569