Thomas Haberl1, Julia Riebandt1, Stephane Mahr1, Guenther Laufer1, Angela Rajek2, Heinrich Schima3, Daniel Zimpfer4. 1. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 2. Department of Anesthesiology and Pain Care, Medical University of Vienna, Vienna, Austria. 3. Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria. 4. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria daniel.zimpfer@meduniwien.ac.at.
Abstract
OBJECTIVE: Avoiding full sternotomy and cardiopulmonary bypass (CPB) could significantly reduce the invasiveness of left ventricular assist device (LVAD) implantation. Therefore, we developed minimally invasive implant strategies for the Heartware® VAD (HVAD) and the Thoratec® HeartMate II (HMII) covering isolated LVAD implantation as well as concomitant valve procedures (aortic/tricuspid). We present the surgical techniques and the initial clinical experience. METHODS: From February 2012 to March 2013, 27 patients (mean age 58 ± 8 years; male 85%; Ischemic Cardiomyopathy 63%; redo surgery 22%; Interagency Registry for Mechanically Assisted Circulatory Support Level I: 29%, II: 22%, III: 33%, IV-VII: 16%) underwent minimally invasive LVAD implantation at our department. Apical cannulation was performed via a left lateral minithoracotomy in HVAD patients (n = 20) or a left subcostal incision in HMII patients (n = 7). The outflow graft anastomosis was performed to the ascending aorta via a right minithoracotomy in the second intercostal space (n = 22) or the right subclavian artery (n = 2). If additional valve procedures (aortic/tricuspid) were necessary (n = 3), a hemisternotomy was performed to access the valve and perform the outflow graft anastomosis. Circulatory support for LVAD implantation was CPB (33%), extracorporeal membrane oxygenation (48%) or off-pump (19%). RESULTS: The minimally invasive approach was feasible in all patients with no need for conversions. Thirty-day and in-hospital mortality were 7.4 and 14.8%, respectively. In-hospital stay was 30.0 ± 22.5 days. One patient (4%) died during follow-up from pump thrombus formation. Three patients (11%) underwent surgical revision for bleeding. CONCLUSIONS: Minimally invasive LVAD implantation is feasible and safe. The very encouraging results obtained in this initial series justify a broad application of this technique.
OBJECTIVE: Avoiding full sternotomy and cardiopulmonary bypass (CPB) could significantly reduce the invasiveness of left ventricular assist device (LVAD) implantation. Therefore, we developed minimally invasive implant strategies for the Heartware® VAD (HVAD) and the Thoratec® HeartMate II (HMII) covering isolated LVAD implantation as well as concomitant valve procedures (aortic/tricuspid). We present the surgical techniques and the initial clinical experience. METHODS: From February 2012 to March 2013, 27 patients (mean age 58 ± 8 years; male 85%; Ischemic Cardiomyopathy 63%; redo surgery 22%; Interagency Registry for Mechanically Assisted Circulatory Support Level I: 29%, II: 22%, III: 33%, IV-VII: 16%) underwent minimally invasive LVAD implantation at our department. Apical cannulation was performed via a left lateral minithoracotomy in HVAD patients (n = 20) or a left subcostal incision in HMII patients (n = 7). The outflow graft anastomosis was performed to the ascending aorta via a right minithoracotomy in the second intercostal space (n = 22) or the right subclavian artery (n = 2). If additional valve procedures (aortic/tricuspid) were necessary (n = 3), a hemisternotomy was performed to access the valve and perform the outflow graft anastomosis. Circulatory support for LVAD implantation was CPB (33%), extracorporeal membrane oxygenation (48%) or off-pump (19%). RESULTS: The minimally invasive approach was feasible in all patients with no need for conversions. Thirty-day and in-hospital mortality were 7.4 and 14.8%, respectively. In-hospital stay was 30.0 ± 22.5 days. One patient (4%) died during follow-up from pump thrombus formation. Three patients (11%) underwent surgical revision for bleeding. CONCLUSIONS: Minimally invasive LVAD implantation is feasible and safe. The very encouraging results obtained in this initial series justify a broad application of this technique.
Authors: Anamika Chatterjee; Christina Feldmann; Guenes Dogan; Jasmin S Hanke; Marcel Ricklefs; Ezin Deniz; Axel Haverich; Jan D Schmitto Journal: J Thorac Dis Date: 2018-06 Impact factor: 2.895
Authors: Silvia Mariani; Tong Li; Karl Bounader; Dietmar Boethig; Alexandra Schöde; Jasmin S Hanke; Jana Michaelis; L Christian Napp; Dominik Berliner; Guenes Dogan; Roberto Lorusso; Axel Haverich; Jan D Schmitto Journal: Ann Cardiothorac Surg Date: 2021-03
Authors: Julia Riebandt; Anne Schaefer; Dominik Wiedemann; Thomas Schlöglhofer; Günther Laufer; Sigrid Sandner; Daniel Zimpfer Journal: Ann Cardiothorac Surg Date: 2021-03
Authors: Leonhard Wert; Jasmin S Hanke; Günes Dogan; Marcel Ricklefs; Anamika Chatterjee; Christina Feldmann; Issam Ismail; L Christian Napp; Axel Haverich; Jan D Schmitto Journal: J Thorac Dis Date: 2018-06 Impact factor: 2.895