Chad E Wagner1, Julian S Bick2, Jason Kennedy2, Nicholas Haglund3, Matthew Danter4, Mary E Davis5, Andrew Shaw2, Simon Maltais4. 1. Departments of *Cardiothoracic Anesthesiology and Critical Care. Electronic address: Chad.e.wagner@vanderbilt.edu. 2. Departments of *Cardiothoracic Anesthesiology and Critical Care. 3. Cardiology. 4. Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN. 5. Cardiology; Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN.
Abstract
OBJECTIVES: The present report describes the authors' initial experience with implantation of the Heartware left ventricular assist devices (HeartWare Inc., Framingham, MA). via a minimally invasive surgical approach without cardiopulmonary bypass. A detailed overview of the anesthesiologist's role during the procedure, characteristics of the patient population, and short-term clinical outcomes are provided, and the clinical considerations that influence the decision to implant this device via an off-pump minimally invasive approach are outlined. DESIGN: Retrospective medical record review. SETTING: University hospital. PARTICIPANTS: Thirteen patients with advanced heart failure deemed candidates for off-pump minimally invasive left ventricular Heartware implantation as a bridge to heart transplantation. INTERVENTIONS: The Heartware left ventricular assist device was implanted in all 13 patients via a minimally invasive approach. MEASUREMENTS AND MAIN RESULTS: One patient required unplanned cardiopulmonary bypass to control bleeding around the left ventricular outflow cannula. The average operating room time was 249.8 minutes±46.2 minutes. Six of 13 patients required no intraoperative red blood cell transfusions. Seven patients were extubated within 12 hours after surgery. Two patients required reintubation within 48 hours. No patients required reoperation for bleeding. Average intensive care unit and hospital lengths of stay were 7.2±3.9 days and 13.4±3.6 days, respectively. There were no in-hospital deaths. CONCLUSIONS: Minimally invasive off-pump left ventricular Heartware implantation is an emerging alternative to placement by midline sternotomy. The authors speculate, based on their limited experience, that an off-pump thoracic strategy may be a desirable option for some patients and that clinical outcomes may be non-inferior to placement by midline sternotomy with cardiopulmonary bypass.
OBJECTIVES: The present report describes the authors' initial experience with implantation of the Heartware left ventricular assist devices (HeartWare Inc., Framingham, MA). via a minimally invasive surgical approach without cardiopulmonary bypass. A detailed overview of the anesthesiologist's role during the procedure, characteristics of the patient population, and short-term clinical outcomes are provided, and the clinical considerations that influence the decision to implant this device via an off-pump minimally invasive approach are outlined. DESIGN: Retrospective medical record review. SETTING: University hospital. PARTICIPANTS: Thirteen patients with advanced heart failure deemed candidates for off-pump minimally invasive left ventricular Heartware implantation as a bridge to heart transplantation. INTERVENTIONS: The Heartware left ventricular assist device was implanted in all 13 patients via a minimally invasive approach. MEASUREMENTS AND MAIN RESULTS: One patient required unplanned cardiopulmonary bypass to control bleeding around the left ventricular outflow cannula. The average operating room time was 249.8 minutes±46.2 minutes. Six of 13 patients required no intraoperative red blood cell transfusions. Seven patients were extubated within 12 hours after surgery. Two patients required reintubation within 48 hours. No patients required reoperation for bleeding. Average intensive care unit and hospital lengths of stay were 7.2±3.9 days and 13.4±3.6 days, respectively. There were no in-hospital deaths. CONCLUSIONS: Minimally invasive off-pump left ventricular Heartware implantation is an emerging alternative to placement by midline sternotomy. The authors speculate, based on their limited experience, that an off-pump thoracic strategy may be a desirable option for some patients and that clinical outcomes may be non-inferior to placement by midline sternotomy with cardiopulmonary bypass.
Authors: Brian A Houston; Rohan J Kalathiya; Steven Hsu; Rahul Loungani; Mary E Davis; Samuel T Coffin; Nicholas Haglund; Simon Maltais; Mary E Keebler; Peter J Leary; Daniel P Judge; Gerin R Stevens; John Rickard; Chris M Sciortino; Glenn J Whitman; Ashish S Shah; Stuart D Russell; Ryan J Tedford Journal: J Heart Lung Transplant Date: 2016-02-09 Impact factor: 10.247
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: Simon Maltais; Mary E Davis; Nicholas A Haglund; Louis Perrault; Sudhir S Kushwaha; John M Stulak; Edward M Boyle Journal: ASAIO J Date: 2016 Nov/Dec Impact factor: 2.872