Midterm Results of Minimally Invasive Left Thoracotomy Fully Magnetically Levitated Left Ventricular Assist Device Implantation.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 09 2021
01 09 2021
Historique:
pubmed:
3
2
2021
medline:
26
11
2021
entrez:
2
2
2021
Statut:
ppublish
Résumé
The aim of the study is to compare outcomes of the patients who underwent HeartMate3 (HM3) implantation with conventional sternotomy (CS) and minimally invasive thoracotomy technique (MILT). From June 2013 to April 2019, 50 patients who underwent isolated HM3 implantation were included. Patients were divided into two groups according to the operative technique; of 50 patients, 28 were implanted with CS and 22 with MILT. All patients were evaluated for mortality, need of inotrope, blood product transfusion, intensive care unit stay, time on mechanical ventilation, and postoperative right ventricular failure. Primary outcomes were early mortality and occurrence of adverse events. Patients characteristics were similar; preoperative central venous pressure (CVP) and the ratio of CVP to pulmonary capillary wedge pressure (CVP/PCWP) were significantly higher in the MILT group versus the CS group (p < 0.05). Intensive care unit stay was significantly shorter in the MILT group (p < 0.05). Incidence of bleeding requiring exploratory sternotomy and postoperative drainage on the first postoperative day were statistically higher in the CS group (p < 0.05). Right ventricular failure was higher in the CS group but was not statistically significant (p = 0.4). There was no significant difference in long-term adverse events. The Kaplan-Meier survival analysis showed no difference between the groups (p = 0.66). The HM3 assist system can be successfully implanted with the MILT technique, which has proved to be safe and reproducible and yields good clinical outcomes.
Identifiants
pubmed: 33528161
doi: 10.1097/MAT.0000000000001358
pii: 00002480-202109000-00008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1006-1011Informations de copyright
Copyright © ASAIO 2020.
Déclaration de conflit d'intérêts
Disclosure: U.K. is the consultant surgeon for Abbott and Medtronic. The other authors have no conflicts of interest to report.
Références
Mehra MR, Naka Y, Uriel N, et al.; MOMENTUM 3 Investigators: A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med 2017.376: 440–450.
Bourque K, Cotter C, Dague C, et al.: Design rationale and preclinical evaluation of the HeartMate 3 left ventricular assist system for hemocompatibility. ASAIO J 2016.62: 375–383.
Mehra MR, Uriel N, Naka Y, et al.; MOMENTUM 3 Investigators: A fully magnetically levitated left ventricular assist device - Final report. N Engl J Med 2019.380: 1618–1627.
McGee E Jr, Danter M, Strueber M, et al.: Evaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: The LATERAL clinical trial. J Heart Lung Transplant 2019.38: 344–351.
Schmitto JD, Rojas SV, Hanke JS, Avsar M, Haverich A: Minimally invasive left ventricular assist device explantation after cardiac recovery: Surgical technical considerations. Artif Organs 2014.38: 507–510.
Strueber M, Meyer AL, Feussner M, Ender J, Correia JC, Mohr FW: A minimally invasive off-pump implantation technique for continuous-flow left ventricular assist devices: Early experience. J Heart Lung Transplant 2014.33: 851–856.
Attisani M, Centofanti P, Baronetto A, et al.: HeartMate 3 left ventricular assist device minimally invasive off-pump implantation. Multimed Man Cardiothorac Surg 2018. 2018doi:10.1510/mmcts.2018.048. Available at: https://mmcts.org/tutorial/1105 .
doi: 10.1510/mmcts.2018.048.
Carrozzini M, Bejko J, Gerosa G, Bottio T: Bilateral mini-thoracotomy approach for minimally invasive implantation of HeartMate 3. Artif Organs 2019.43: 593–595.
Hanke JS, Rojas SV, Dogan G, et al.: First series of left ventricular assist device exchanges to HeartMate 3. Eur J Cardiothorac Surg 2017.51: 887–892.
Pfister R, Tozzi P, Hullin R, et al.: HeartMate 3 implantation via left antero-lateral thoracotomy to avoid resternotomy in high risk patients. Multimed Man Cardiothorac Surg 2018. doi:10.1510/mmcts.2018.026. Available at: https://mmcts.org/tutorial/999 .
doi: 10.1510/mmcts.2018.026.
Riebandt J, Wiedemann D, Laufer G, Zimpfer D: Sternotomy sparing thoratec HeartMate 3 implantation via bilateral minithoracotomy. Innovations (Phila) 2018.13: 74–76.
Saeed D, Sixt S, Albert A, Lichtenberg A: Minimally invasive off-pump implantation of HeartMate 3 left ventricular assist device. J Thorac Cardiovasc Surg 2016.152: 1446–1447.
Schmitto JD, Krabatsch T, Damme L, Netuka I: Less invasive HeartMate 3 left ventricular assist device implantation. J Thorac Dis 2018.10suppl 15S1692–S1695.
Kocabeyoglu SS, Kervan U, Sert DE, et al.: Is it possible to implant HeartMate 3 less invasively? New pump, new approach. Artif Organs 2018.42: 1132–1138.
Matthews JC, Koelling TM, Pagani FD, Aaronson KD: The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol 2008.51: 2163–2172.
Slaughter MS, Rogers JG, Milano CA, et al.; HeartMate II Investigators: Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009.361: 2241–2251.
Patel CB, Cowger JA, Zuckermann A: A contemporary review of mechanical circulatory support. J Heart Lung Transplant 2014.33: 667–674.
Popov AF, Mohite PN, Sabashnikov A, et al.: Minimally invasive HeartWare LVAD implantation through single left thoracotomy. J Artif Organs 2015.18: 170–172.
Sileshi B, Haglund NA, Davis ME, et al.: In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device. J Heart Lung Transplant 2015.34: 107–112.
Haberl T, Riebandt J, Mahr S, et al.: Viennese approach to minimize the invasiveness of ventricular assist device implantation†. Eur J Cardiothorac Surg 2014.46: 991–996.
Schmitto JD, Molitoris U, Haverich A, Strueber M: Implantation of a centrifugal pump as a left ventricular assist device through a novel, minimized approach: Upper hemisternotomy combined with anterolateral thoracotomy. J Thorac Cardiovasc Surg 2012.143: 511–513.
Argiriou M, Kolokotron SM, Sakellaridis T, et al.: Right heart failure post left ventricular assist device implantation. J Thorac Dis 2014.6suppl 1S52–S59.
Zhigalov K, Szczechowicz M, Mashhour A, et al.: Left ventricular assist device implantation with concomitant tricuspid valve repair: Is there really a benefit? J Thorac Dis 2019.11suppl 6S902–S912.
Heatley G, Sood P, Goldstein D, et al.; MOMENTUM 3 Investigators: Clinical trial design and rationale of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) investigational device exemption clinical study protocol. J Heart Lung Transplant 2016.35: 528–536.
Wood KL, Ayers BC, Sagebin F, et al.: Complete sternal-sparing HeartMate 3 implantation: A case series of 10 consecutive patients. Ann Thorac Surg 2019.107: 1160–1165.