Complete Sternal-Sparing HeartMate 3 Implantation: A Case Series of 10 Consecutive Patients

Wood, Katherine; Ayers, Brian; Sagebin, Fabio; Vidula, Himabindu; Thomas, Sabu; Alexis, Jeffrey D.; Barrus, Bryan; Knight, Peter A.; Prasad, Sunil; Gošev, Igor

doi:10.1016/j.athoracsur.2018.10.005

Cited by 37 publications

(65 citation statements)

References 15 publications

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“…Minimally invasive cardiac procedures have demonstrated numerous patient benefits compared to median sternotomy including shorter time on mechanical ventilation and shorter ICU length of stay, but associated postoperative pain threatens to negate these benefits if not properly managed. Thus, as these procedures are increasingly performed for cardiac surgery there is a need for new postoperative pain management modalities.…”

Section: Discussionmentioning

confidence: 99%

“…We retrospectively reviewed all patients who underwent CSS LVAD implantation at our institution from February 2018 to August 2018. This less‐invasive approach utilizes bilateral thoracotomies as previously described . Patients who received a postoperative nerve block were compared with patients who did not receive a block.…”

Section: Methodsmentioning

confidence: 99%

“…This less-invasive approach utilizes bilateral thoracotomies as previously described. 9 Patients who received a postoperative nerve block were compared with patients who did not receive a block.…”

Section: Subject Selectionmentioning

confidence: 99%

“…Early reports of these techniques have shown comparable survival and complication rates as the traditional sternotomy approach, but with improved postoperative courses including less bleeding and shorter overall hospital length of stay . At our institution, we utilize a complete sternal‐sparing (CSS) approach via bilateral thoracotomy incisions for LVAD implantation . From our experience, this less‐invasive technique has led to improved outcomes, but it is frequently associated with significant postoperative pain.…”

Section: Introductionmentioning

confidence: 98%

“…[5][6][7][8] At our institution, we utilize a complete sternal-sparing (CSS) approach via bilateral thoracotomy incisions for LVAD implantation. 9 From our experience, this lessinvasive technique has led to improved outcomes, but it is frequently associated with significant postoperative pain.…”

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confidence: 99%

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Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

et al. 2019

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Background Less‐invasive techniques for left ventricular assist device (LVAD) implantation have shown promising outcomes but are associated with significant postoperative pain. We aim to investigate the use of ultrasound‐guided regional nerve blocks to improve pain management during these procedures. Methods We retrospectively reviewed patients implanted with a HeartMate 3 LVAD via complete sternal‐sparing (CSS) approach at our institution from February 2018 to July 2018. Patients were grouped based on their postoperative pain management plan—those who received a regional nerve block plus multimodal analgesia and a control group who received standard multimodal analgesia alone. Pain scores and analgesic use were recorded for all patients during the initial 72 hours postoperatively. Results Preoperative characteristics were similar between cohorts. Of the 28 patients included in the study, 15 (54%) received a postoperative regional nerve block. Patients who received a nerve block had significantly lower pain scores and required a lower dose of opioid analgesics (70.7 ± 13.9 vs 124.6 ± 19.3 morphine equivalents, P = 0.029) during the first 72 hours postoperatively. There was no difference in time to extubation, intensive care unit length of stay, or hospital length of stay. Conclusions Optimizing postoperative analgesia using a regional nerve block is associated with decreased opioid use and decreased postoperative pain after CSS LVAD implantation. Regional nerve blocks should be included as part of a protocol‐based postoperative pain management program.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Subject Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

mentioning

confidence: 99%

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Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

et al. 2019

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Incisions and Decisions: Implantation Technique for DurableLVADs

Mariani,

Bounader,

Schmitto

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Pressure‐dimension index and left ventricular sphericity index following HeartMate II and HeartMate 3 implantation

Schnoering,

Khattab,

Akhyari

et al. 2024

ESC Heart Failure

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AimsThis study aimed to compare the changes in the left ventricle (LV) and right ventricle (RV) geometry and performance after the implantation of HeartMate II (HMII) and HeartMate 3 (HM3). In addition, we investigated whether the echocardiographic parameters LV sphericity index (LVSI) and the novel pressure‐dimension index (PDI) can predict post‐operative right ventricular failure (RVF).Methods and resultsBetween 2012 and 2020, 46 patients [HMII (n = 22) and HM3 (n = 24)] met the study's criteria and had echocardiography tests pre‐operatively, 6 and 12 months post‐operatively. The LVSI and PDI were calculated together with the standard LV and RV echocardiographic parameters. The mean follow‐up was 24 ± 7 months. In both groups, the LV end‐diastolic diameter (LVEDD) significantly decreased 12 months post‐operatively compared with the pre‐operative values (HMII: 6.4 ± 1.4 cm vs. 5.7 ± 0.9 cm, P = 0.040; HM3: 6.7 ± 1.3 cm vs. 5.5 ± 0.9 cm, P < 0.01, respectively). RV function 12 months post‐operatively was better in the HM3 group than in the HMII group, as indicated by a significantly higher RV fractional area change (RVFAC) in the HM3 group than in the HMII group 12 months post‐operatively (35 ± 12% vs. 26 ± 16%, P = 0.039), significantly higher tricuspid annular plane systolic excursion (TAPSE) in the HM3 group 12 months post‐operatively compared with the HMII group (13.9 ± 1.9 mm vs. 12.0 ± 2.1 mm, P = 0.002), and the tissue Doppler estimated tricuspid annular systolic velocity (TASV) was also significantly higher in the HM3 group 12 months post‐operatively compared with the HMII group (11.5 ± 2.7 mm/s vs. 9.9 ± 1.5 mm/s, P = 0.020). The LVSI value was significantly higher 12 months post‐operatively in the HMII group than in the HM3 group (1.2 ± 0.4 vs. 0.8 ± 0.2, P = 0.001, respectively), indicating worse geometric changes. The PDI decreased 12 months post‐operatively in the HM3‐group compared with the baseline (3.4 ± 1.4 mmHg/cm2 vs. 2.0 ± 0.8 mmHg/cm2, P < 0.001). In the univariate and multivariate analyses, only the pre‐operative PDI was a predictor of post‐operative RVF [odds ratio: 3.84 (95% CI: 1.53–18.16, P = 0.022)]. The area under the curve for pre‐operative PDI was 0.912. The 2 year survival was significantly better in the HM3 group (log‐rank, P = 0.042).ConclusionsThe design of HM3 offered better geometrical preservation of the LV and enabled normal PDI values, leading to improved RV function, as indicated by better RVFAC, TAPSE, and TASV values. The use of pre‐operative PDI as an additional tool for established risk scores might offer a better pre‐operative predictor of RVF.

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Complete Sternal-Sparing HeartMate 3 Implantation: A Case Series of 10 Consecutive Patients

Cited by 37 publications

References 15 publications

Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

Incisions and Decisions: Implantation Technique for DurableLVADs

Pressure‐dimension index and left ventricular sphericity index following HeartMate II and HeartMate 3 implantation

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