Viennese approach to minimize the invasiveness of ventricular assist device implantation

• Published in: European journal of cardio-thoracic surgery Vol. 46; no. 6; pp. 991 - 996
• Main Authors: Haberl, Thomas, Riebandt, Julia, Mahr, Stephane, Laufer, Guenther, Rajek, Angela, Schima, Heinrich, Zimpfer, Daniel
• Format: Journal Article
• Language: English
• Published: Germany 01-12-2014
• Subjects: Aged; Austria; Cardiomyopathies - surgery; Female; Heart-Assist Devices; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Myocardial Ischemia - surgery; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; Retrospective Studies; Austria; Ventricular assist device; Minimal invasive implantation
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezu051

Avoiding full sternotomy and cardiopulmonary bypass (CPB) could significantly reduce the invasiveness of left ventricular assist device (LVAD) implantation. Therefore, we developed minimally invasive implant strategies for the Heartware® VAD (HVAD) and the Thoratec® HeartMate II (HMII) covering isolated LVAD implantation as well as concomitant valve procedures (aortic/tricuspid). We present the surgical techniques and the initial clinical experience.
From February 2012 to March 2013, 27 patients (mean age 58 ± 8 years; male 85%; Ischemic Cardiomyopathy 63%; redo surgery 22%; Interagency Registry for Mechanically Assisted Circulatory Support Level I: 29%, II: 22%, III: 33%, IV-VII: 16%) underwent minimally invasive LVAD implantation at our department. Apical cannulation was performed via a left lateral minithoracotomy in HVAD patients (n = 20) or a left subcostal incision in HMII patients (n = 7). The outflow graft anastomosis was performed to the ascending aorta via a right minithoracotomy in the second intercostal space (n = 22) or the right subclavian artery (n = 2). If additional valve procedures (aortic/tricuspid) were necessary (n = 3), a hemisternotomy was performed to access the valve and perform the outflow graft anastomosis. Circulatory support for LVAD implantation was CPB (33%), extracorporeal membrane oxygenation (48%) or off-pump (19%).
The minimally invasive approach was feasible in all patients with no need for conversions. Thirty-day and in-hospital mortality were 7.4 and 14.8%, respectively. In-hospital stay was 30.0 ± 22.5 days. One patient (4%) died during follow-up from pump thrombus formation. Three patients (11%) underwent surgical revision for bleeding.
Minimally invasive LVAD implantation is feasible and safe. The very encouraging results obtained in this initial series justify a broad application of this technique.