Bantayehu Sileshi1, Nicholas A Haglund2, Mary E Davis3, Nicole M Tricarico4, John M Stulak5, Zain Khalpey6, Matthew R Danter4, Robert Deegan1, Jason Kennedy1, Mary E Keebler2, Simon Maltais7. 1. Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee. 2. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 3. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 5. Department of Cardiothoracic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. 6. Division of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, Arizona. 7. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: simon.maltais@vanderbilt.edu.
Abstract
BACKGROUND: Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy. METHODS: Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores. RESULTS: Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups. CONCLUSIONS: An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach. Published by Elsevier Inc.
BACKGROUND: Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy. METHODS: Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores. RESULTS: Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups. CONCLUSIONS: An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach. Published by Elsevier Inc.
Entities:
Keywords:
heart failure; left thoracotomy; left ventricular assist device; off-pump surgery; peri-operative outcomes; surgical approach
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