A minimally invasive off-pump implantation technique for continuous-flow left ventricular assist devices: Early experience

Strueber, M.; Meyer, Anna; Feussner, Markus; Ender, Joerg; Correia, Joao-Carlos; Mohr, Friedrich–Wilhelm

doi:10.1016/j.healun.2014.05.016

Cited by 55 publications

(69 citation statements)

References 14 publications

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“…Strategies aimed at minimizing RV damage, perhaps through pericardial-sparing techniques or avoiding cardiopulmonary bypass, should be further studied. 44,45 …”

Section: Discussionmentioning

confidence: 99%

Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation: A multi-center hemodynamic analysis

Houston

Kalathiya

Hsu

et al. 2016

The Journal of Heart and Lung Transplantation

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Background Right ventricular (RV) failure is a source of morbidity and mortality after left ventricular assist device (LVAD) implantation. We sought to define hemodynamic changes in afterload and RV adaption to afterload both early after implantation and with prolonged LVAD support. Methods We reviewed right heart catheterization (RHC) data from participants who underwent continuous-flow LVAD implantation at our institutions (n=244), excluding those on inotropic or vasopressor agents, pulmonary vasodilators, or additional mechanical support at any RHC. Hemodynamic data was assessed at five time intervals: 1) pre-LVAD (within 6 months), 2) early post-LVAD (0–6 months), 3) 7–12 months, 4) 13–18 months and 3) very-late post-LVAD (18–36 months). Results Sixty participants met the inclusion criteria. All measures of right ventricular load (effective arterial elastance, pulmonary vascular compliance and pulmonary vascular resistance) improved between the pre- and early post-LVAD time periods. Despite decreasing load and pulmonary capillary artery pressure (PAWP), RAP remained unchanged and the RAP:PAWP ratio worsened early post-LVAD (0.44 [0.38, 0.63] versus 0.77 [0.59, 1.0], p<0.001), suggesting a worsening of RV adaptation to load. With continued LVAD support, both RV load and RAP:PAWP decreased in a steep, linear and dependent manner. Conclusion Despite reducing RV load, LVAD implantation leads to worsened RV adaptation. With continued LVAD support, both RV afterload and RV adaptation improve, and their relationship remains constant over time post-LVAD. These findings suggest the RV afterload sensitivity increases after LVAD implantation, which has important clinical implications for patients struggling with RV failure.

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“…Strategies aimed at minimizing RV damage, perhaps through pericardial-sparing techniques or avoiding cardiopulmonary bypass, should be further studied. 44,45 …”

Section: Discussionmentioning

confidence: 99%

Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation: A multi-center hemodynamic analysis

Houston

Kalathiya

Hsu

et al. 2016

The Journal of Heart and Lung Transplantation

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“…Bedridden patients inevitably develop muscle atrophy, which compromises respiratory mechanics and prolongs wound healing, while an early implementation of exercise training represents a key therapeutic intervention in frail patients . Nonetheless, the favorable effects of minimally invasive LVAD implantation can go far beyond a hastened physical recovery: some authors showed a decrease in the rate of right heart failure compared to the standard surgical approach . This has been linked to the avoidance of pericardial opening, which could allow for a preservation of right ventricle geometry and, therefore, function .…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Implantation of Continuous Flow Left Ventricular Assist Devices: The Evolution of Surgical Techniques in a Single‐Center Experience

et al. 2018

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In this work we aimed to evaluate the evolution of our surgical experience with the implantation of a continuous flow left ventricular assist device (LVAD), from the original full sternotomy approach to less invasive surgical strategies including mini-sternotomy and/or mini-thoracotomies. We reviewed all consecutive patients implanted with a continuous flow LVAD at our Institute. To exclude the possible bias related to the device used, out of 91 collected LVADs implants, we selected only those patients (n = 42) who received, between 2012 and 2015, the HeartWare HVAD. The analysis focused on the surgical approach used for the LVAD implant. Most of the patients (95%) were affected by dilated or ischemic cardiomyopathy, with an INTERMACS class I-II in the majority of cases (77%). The LVAD implant was performed through a full sternotomy in 10 patients (24%); the remaining 32 cases (76%) were managed with minimally invasive procedures. These were left mini-thoracotomy with upper mini-sternotomy (20 patients, 62%), right and left mini-thoracotomy (7 patients, 22%), and a recently developed left mini-thoracotomy with outflow graft anastomosis to the left axillary artery (5 patients, 16%). The most common adverse event on device was right heart failure (26%). Eighteen patients (43%) were transplanted. Overall estimated 24 months survival (on device or after transplant) was 68 ± 7%. The causal analysis, adjusted by propensity score weighting baseline data and sample size, showed that left mini-thoracotomy with outflow anastomosis to the left axillary artery resulted in a significantly reduced rate of post implant right heart failure (P < 0.01), and mechanical ventilation time (P = 0.049). To conclude, in our series, by applying mini-invasive implant techniques in the majority of cases, mid-term survival of continuous flow LVADs in severely compromised patients was satisfactory. In the adjusted analysis, the left anterior mini-thoracotomy with outflow anastomosis to the left axillary artery showed the most favorable results.

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“…Recently, many centers reported positive outcome when the LVAD is implanted using a minimally invasive approach. 1,2 The main drawback of these minimally invasive approach is the feasibility of RVAD implantation with direct cannulation of the pulmonary artery in cases of RVF. Therefore, many surgeons tend to use temporary peripheral venoarterial extracorporeal life support in this setting.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Right Ventricular Assist Device Implantation in a Patient with HeartWare left ventricular Assist Device

Maxhera

Albert²,

Westenfeld³

et al. 2015

ASAIO Journal

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Many centers reported positive outcome after left ventricular assist devices (LVADs) implantation using a minimally invasive approach. The main drawback of this minimally invasive approach is the feasibility of right ventricular assist device (RVAD) implantation with direct cannulation of the pulmonary artery in cases of perioperative right ventricular failure (RVF). We report our experience with a 41-year-old male patient who was supported with a temporary RVAD using J-sternotomy approach for RVF after LVAD implantation. No technical issue was encountered, and the patient's condition stabilized immediately after RVAD implantation. However, several days later, the patient developed severe septic shock caused by pneumonia and died on the postoperative day 15 after RVAD implantation.

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A minimally invasive off-pump implantation technique for continuous-flow left ventricular assist devices: Early experience

Cited by 55 publications

References 14 publications

Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation: A multi-center hemodynamic analysis

Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation: A multi-center hemodynamic analysis

Minimally Invasive Implantation of Continuous Flow Left Ventricular Assist Devices: The Evolution of Surgical Techniques in a Single‐Center Experience

Minimally Invasive Right Ventricular Assist Device Implantation in a Patient with HeartWare left ventricular Assist Device

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