Is it Possible to Implant HeartMate 3 Less Invasively? New Pump, New Approach

Kocabeyoğlu, Sınan Sabit; Kervan, Ümit; Sert, Doğan Emre; Ünal, Ertekin Utku; Demirkan, Burcu; Güray, Yeşım; Beyazal, Osman Fehmi; Karahan, Mehmet; Paç, Mustafa

doi:10.1111/aor.13289

Cited by 25 publications

(31 citation statements)

References 20 publications

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“…In this study, despite 25% of patients having undergone previous cardiac surgery, only 3.8% of cases required a re-thoracotomy. Again, these data mirror the available literature on less-invasive LVAD implantation where rates of re-operations for bleeding are 0% to 13.6% (21,22,43). Minimization of bleeding allows early anticoagulation and prevention of pump thrombosis, while the low transfusion rate may decrease systemic inflammation and sensitization.…”

Section: Discussionsupporting

confidence: 72%

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Mariani¹,

Li²,

Bounader³

et al. 2021

Ann Cardiothorac Surg

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Background: Worse outcomes in women compared to men undergoing left ventricular assist device (LVAD) implantation remain an underestimated problem in heart failure (HF) patients. With device miniaturization, less-invasive LVAD implantation techniques have gained relevance, but their impact on outcomes in women is unknown. This study investigates sex-related differences in patients undergoing LVAD implantation through less-invasive procedures.Methods: This retrospective single-center cohort study included patients who underwent isolated LVAD implantation between 2011 and 2018 through less-invasive techniques. Propensity score matching (PSM) was utilized to balance preoperative heterogeneity. Primary endpoint was two-year survival, and secondary endpoints included long-term survival, surgical outcomes and postoperative adverse events. Results: Baseline analysis of 191 patients (females 18.3%) showed differences in terms of age [female (median, 52; IQR, 47-61); male (median, 58.5; IQR, 49-66); P=0.005], underlying diagnosis (P<0.001), INTERMACS profile (P=0.009), history of previous cardiac surgery (P=0.049) and preoperative creatinine values [female (median, 110; IQR, 71-146); male (median, 126; IQR, 9-168); P=0.049]. Over a follow-up of 460.68 patient-years, Kaplan-Meyer analysis showed better survival in females (P=0.027) and a similarprobability of cardiac transplantation (P=0.288). After PSM, females showed higher needs for intraoperative fresh frozen plasma (P=0.044) and platelets (P=0.001) but comparable postoperative outcomes. No sexrelated differences were noticed regarding two-year outcomes, long-term survival and adverse events. LVADrelated infections remained the most common complication with males experiencing more pump infections than women (P=0.050).Conclusions: Patients receiving less-invasive LVAD implantation do not show significant sex-related differences in short and long-term outcomes and survival. Prospective studies are needed to evaluate the role of less-invasive techniques in reducing sex-based disparities after LVAD implantation.

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Section: Discussionsupporting

confidence: 72%

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Mariani¹,

Li²,

Bounader³

et al. 2021

Ann Cardiothorac Surg

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“…Our results support previous studies investigating the use of less-invasive LVAD implantation techniques. [7][8][9][10][11][12] The LATERAL trial represents the largest prospective cohort of less-invasive LVAD patients reported to date. 8 Using the HeartWare TM HVAD, McGee et al report 92% overall 6-month survival utilizing a left thoracotomy with either upper hemisternotomy or right thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Utilizing lessons learned from less-invasive coronary artery bypass and valvular procedures, early reports of less-invasive LVAD implantation have demonstrated numerous potential benefits including less perioperative bleeding, shorter time on mechanical ventilation, fewer cases of severe right ventricular (RV) failure and faster time to discharge. [7][8][9][10][11][12][13] The goal of this study was to investigate the safety and efficacy of utilizing the complete sternal-sparing (CSS) approach for implantation of a fully magnetically levitated LVAD in complex surgical patients with a history of prior cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Complete Sternal-Sparing Approach Improves Outcomes for Left Ventricular Assist Device Implantation in Patients With History of Prior Sternotomy

Ayers

Sagebin

Wood

et al. 2020

Innovations�(Phila)

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Objective Early reports of less invasive techniques for left ventricular assist device (LVAD) implantation have demonstrated promising results. We sought to investigate the safety and feasibility of implementing the complete sternal-sparing (CSS) approach for LVAD implantation in patients with a history of prior cardiac operation. Methods This was a retrospective review of prospectively collected data for all patients implanted with a fully magnetically levitated LVAD from April 2017 through December 2018. Patients were dichotomized based on surgical approach: CSS or full median sternotomy (FS). Perioperative complications and overall survival were compared between cohorts. Results Of the 29 eligible patients, 15 (52%) were implanted via the CSS approach and 14 (48%) via FS. Preoperative characteristics were similar between cohorts. Overall survival to discharge was 93% for CSS compared to 71% for FS ( P = 0.169). The CSS cohort demonstrated fewer postoperative complications, including fewer cases of severe right ventricular failure ( P = 0.006) and less blood product utilization ( P = 0.015). Median hospital length of stay was significantly shorter for the CSS cohort (median 13 vs 32.5 days, P = 0.016). Neither cohort had any 30-day readmissions. Conclusions Early data suggest that the CSS technique is a safe and effective technique for patients with a history of prior sternotomy. Further studies are needed to validate this single-center experience.

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“…The theoretical advantages include the preservation of the RV geometry during surgery by avoiding cardiac luxation and preserving the pericardium. The possible protective role of less invasive VAD surgery has been shown in several studies by the low incidence of postoperative RV failure and reduced need for RV assist devices (7,(35)(36)(37)(38)(39). Gosev et al compared the results between sternal-sparing and conventional techniques in 105 patients implanted with HM3 LVAD.…”

Section: Less-invasive Lvad For Redo Cases and Vad Exchange Or Explanmentioning

confidence: 99%

Minimally invasive ventricular assist device implantation

Al-Naamani¹,

Fahr²,

Khan³

et al. 2021

J Thorac Dis

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Durable mechanical circulatory support (MCS) systems are established therapy option in patients with end-stage heart failure, with increasing importance during the last years due to donor organ shortage. Left ventricular assist devices (LVADs) are traditionally implanted through median sternotomy (MS). However, improvement in the pump designs during the last years led to evolvement of new surgical approaches that aim to reduce the invasiveness of the procedure. Numerous reports and studies have shown the viability and possible advantages of less-invasive approach compared to the sternotomy approach. The less invasive implant strategies for LVADs, while vague in definition, are characterized by minimizing surgical trauma and if possible, cardio-pulmonary bypass related complications. Usually it involves minimizing or completely avoiding sternal trauma, avoiding heart luxation while simultaneously leaving the major part of pericardium intact. There is no consensus between the centers regarding the ideal approach for LVAD implantation. Some centers, like our center, perform by default VAD implantation using less invasive approach in almost all patients and some centers use only sternotomy approach. The aim of this review article is to shed light on the currently available less invasive options of LVAD implantation, with particular focus on the centrifugal pumps, and their possible advantages compared to traditional sternotomy approach.

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Is it Possible to Implant HeartMate 3 Less Invasively? New Pump, New Approach

Cited by 25 publications

References 20 publications

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Complete Sternal-Sparing Approach Improves Outcomes for Left Ventricular Assist Device Implantation in Patients With History of Prior Sternotomy

Minimally invasive ventricular assist device implantation

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