Implantation of a fully magnetically levitated left ventricular assist device using a sternal-sparing surgical technique

Gošev, Igor; Wood, Katherine; Ayers, Brian; Barrus, Bryan; Knight, Peter A.; Alexis, Jeffrey D.; Vidula, Himabindu; Lander, Heather; Wyrobek, Julie; Cheyne, C.; Goldenberg, Ilan; McNitt, Scott; Prasad, Sunil

doi:10.1016/j.healun.2019.09.012

Cited by 39 publications

(62 citation statements)

References 21 publications

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“…The same group 18 presented a large series comparing CSS to sternotomy for Heartmate 3. There was a high prevalence of Intermacs 1 (41% CSS, 34% sternotomy) and ECMO (22% CSS, 13% sternotomy).…”

Section: Discussionmentioning

confidence: 99%

Outcomes with temporary mechanical circulatory support before minimally invasive centrifugal left ventricular assist device

et al. 2020

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Background Despite improved survival and morbidity after durable left ventricular assist device (dLVAD), outcomes for cardiogenic shock patients are suboptimal. Temporary mechanical circulatory support (tMCS) can permit optimization before dLVAD. Excellent outcomes have been observed using minimally‐invasive dLVAD implantation. However, some feel tMCS contraindicates this approach. To evaluate whether left thoracotomy/hemisternotomy (LTHS) dLVAD placement is safe in this setting, we compared patients who did and did not require tMCS. Methods Outcomes for patients receiving dLVADs via LTHS were compared among those bridged with extracorporeal membrane oxygenation (ECMO), intra‐aortic balloon pump (IABP), or no tMCS. We evaluated demographics, comorbidities, laboratory and hemodynamic data, and intraoperative and postoperative outcomes. Results Eighty‐three patients underwent LTHS dLVAD placement. Fifty did not require tMCS, while 22 (26%) required IABP, and 11 (13%) ECMO. Non‐tMCS patients were primarily Intermacs 3 (56%), while IABP recipients were mainly Intermacs 2 (45%). All patients with ECMO were Intermacs 1. Patients with tMCS had worse end‐organ function. Operative outcomes were similar except more concomitant procedures and red‐cell transfusions in patients with ECMO. Intensive care unit and hospital length of stay and inotrope duration were also similar. There were no differences in bleeding, stroke, and infection rates. Three‐ and 12‐month survival were: no tMCS: 94%, 86%; IABP: 100%, 88%; and ECMO: 81%, 81% (P = .45). Conclusions Patients with cardiogenic shock can safely undergo LTHS dLVAD implantation after stabilization with ECMO or IABP. Outcomes and complications in these patients were comparable to a less severely ill cohort without tMCS.

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Section: Discussionmentioning

confidence: 99%

Outcomes with temporary mechanical circulatory support before minimally invasive centrifugal left ventricular assist device

et al. 2020

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“…The miniaturization of the pumps described above and their placement within the pericardial space eliminate the need for an abdominal pump pocket [6][7][8][9][10][11][12]. Less surgical trauma and associated bleeding shortens the recovery time and reduces the likelihood of infectious complications, which often occur as a result of blood transfusions and prolonged intensive care [23][24][25][26][27][28][29][30][31][32].…”

Section: Surgical Issuesmentioning

confidence: 99%

“…In cases of heavy calcification, proximal graft anastomosis, or pseudoaneurysms, the ascending aorta is contraindicated as the outflow graft anastomosis site. Alternative sites, such as the descending thoracic aorta, supraceliac abdominal aorta, innominate artery, and subclavian arteries, have yielded acceptable results [23][24][25][26][27][28][29][30][31][32].…”

Section: Surgical Issuesmentioning

confidence: 99%

Durable Continuous-Flow Mechanical Circulatory Support: State of the Art

Loforte

Botta

Boschi

et al. 2021

Hearts

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Implantable mechanical circulatory support (MCS) systems for ventricular assist device (VAD) therapy have emerged as an important strategy due to a shortage of donor organs for heart transplantation. A growing number of patients are receiving permanent assist devices, while fewer are undergoing heart transplantation (Htx). Continuous-flow (CF) pumps, as devices that can be permanently implanted, show promise for the treatment of both young and old patients with heart failure (HF). Further improvement of these devices will decrease adverse events, enable pulse modulation of continuous blood flow, and improve automatic remote monitoring. Ease of use for patients could also be improved. We herein report on the current state of the art regarding implantable CF pumps for use as MCS systems in the treatment of advanced refractory HF.

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“…Herein we report the case of a HeartMate 3 exchange via bilateral minithoracotomy incisions for treatment of pump and outflow graft thrombosis. Sternal‐sparing approaches for primary LVAD implantation have previously demonstrated early evidence of numerous potential benefits compared with sternotomy, including fewer transfusions, less right ventricular failure, and shorter hospital length of stay 4,5 . Nonsternotomy approaches also afford the benefit of potentially improving the speed and safety of a subsequent orthotopic heart transplantation by reducing the inherent risks of re‐entry sternotomy by decreasing postoperative sternal adhesions.…”

Section: Commentmentioning

confidence: 99%

“…Sternal-sparing approaches for primary LVAD implantation have previously demonstrated early evidence of numerous potential benefits compared with sternotomy, including fewer transfusions, less right ventricular failure, and shorter hospital length of stay. 4,5 Nonsternotomy approaches also afford the benefit of potentially improving the speed and safety of a subsequent orthotopic heart transplantation by reducing the inherent risks of re-entry sternotomy by decreasing postoperative sternal adhesions. To preserve these potential benefits of less invasive primary implantation, adverse events requiring LVAD exchange must also be managed through nonsternotomy approaches.…”

Section: Commentmentioning

confidence: 99%

HeartMate 3 pump exchange via sternal‐sparing bilateral minithoracotomies

et al. 2020

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As median survival for left ventricular assist device (LVAD) patients increases, the incidence of adverse events requiring device exchange is likely to increase as well. Less invasive surgical approaches for device exchange of older generation pumps have demonstrated multiple potential benefits compared with median sternotomy. However, there remains a paucity of data in regard to less invasive surgical techniques for the exchange of the newest generation intrapericardial devices. In this report we describe a complete sternal‐sparing technique for the LVAD exchange of a HeartMate 3 via bilateral minithoracotomies.

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Implantation of a fully magnetically levitated left ventricular assist device using a sternal-sparing surgical technique

Cited by 39 publications

References 21 publications

Outcomes with temporary mechanical circulatory support before minimally invasive centrifugal left ventricular assist device

Outcomes with temporary mechanical circulatory support before minimally invasive centrifugal left ventricular assist device

Durable Continuous-Flow Mechanical Circulatory Support: State of the Art

HeartMate 3 pump exchange via sternal‐sparing bilateral minithoracotomies

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