023FIRST RESULTS OF 111 MINIMALLY-INVASIVE LEFT VENTRICULAR ASSIST DEVICE IMPLANTATIONS AT A SINGLE-CENTRE

• Published in: Interactive cardiovascular and thoracic surgery Vol. 19; no. suppl_1; p. S8
• Main Authors: Schmitto, J.D., Rojas, S.V., Avsar, M., Hanke, J.S., Berliner, D., Bara, C., Bauersachs, J., Haverich, A.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.23

Objectives: Left ventricular assist devices (LVADs) are gaining more importance in the treatment of terminal heart failure. The development of miniaturised technologies has generated considerably novel LVAD systems enabling less traumatic implantation procedures with the potential of lowering perioperative risk. So far, clinical experience with minimally-invasive LVAD surgery was limited to only a few experienced centres. In this study, we elucidate the operative outcome of the first series of 100 patients who received minimally-invasive LVAD surgery at a single institution.
Methods: We reviewed the outcome of 111 end-stage heart failure patients who underwent minimally-invasive LVAD implantation (HVAD, HeartWare) in our institution between 2011 and 2013. Patients were operated using the “Hannover”-LVAD-technique: upper hemisternotomy and combined with a left-sided anterolateral thoracotomy.
Results: Between 2011 and 2014, 111 minimally-invasive LVAD implantations were performed at our institution (78% male, 22% female; mean age 52 ± 4; dilated cardiomyopathy (DCM) 42.6%; ischaemic cardiomyopathy (ICM) 44.4%, other aetiologies 13%). Thirty-day mortality was revealed to be 5.2%, 90-day mortality 9.0% and 1-year survival 88%). Compared to literature and historical data of conventional LVAD implantations, patients who were operated minimally-invasively showed a lower bleeding incidence (9.6%), which is also indicated by lower amounts of applied packed red blood cells (mean 4.9 rbc), shorter mean ICU stay (9.3 days), and a lower incidence of right heart failure (4.6%).
Conclusion: Minimally-invasive LVAD implantations are proven to be safe and associated with a lower perioperative complication and mortality rate. By using this technique (upper hemisternotomy plus anterolateral thoracotomy) the intra-hospital outcome was significantly improved (as especially indicated by lower bleeding incidences and lower right heart failure rates) compared to patients treated by the standard surgical technique.