title: In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device.
abstract: BACKGROUND
  Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.
  
  
  METHODS
  Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.
  
  
  RESULTS
  Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.
  
  
  CONCLUSIONS
  An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.
authors.affiliation: Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bantayehu
authors.initials: B
authors.lastname: Sileshi
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.affiliation: Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tricarico
authors.affiliation: Department of Cardiothoracic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Zain
authors.initials: Z
authors.lastname: Khalpey
authors.affiliation: Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Danter
authors.affiliation: Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Robert
authors.initials: R
authors.lastname: Deegan
authors.affiliation: Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jason
authors.initials: J
authors.lastname: Kennedy
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Keebler
authors.affiliation: Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: simon.maltais@vanderbilt.edu.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult
keywords: heart failure; left thoracotomy; left ventricular assist device; off-pump surgery; peri-operative outcomes; surgical approach