Robotic Left Ventricular Assist Device Implantation Using Left Thoracotomy Approach in Patients with Previous Sternotomies.
Left ventricular assist devices (LVADs) are commonly used as either a bridge-to-transplant or a destination therapy. The traditional approach for LVAD implantation is via median sternotomy, but many candidates for this procedure have a history of failed cardiac surgeries and previous sternotomy. Redo sternotomy increases the risk of heart surgery, particularly in the setting of advanced heart failure. Robotics facilitates a less invasive approach to LVAD implantation that circumvents some of the morbidity associated with a redo sternotomy. We compared the outcomes of all patients at our institution who underwent LVAD implantation via either a traditional sternotomy or using robotic assistance. The robotic cohort showed reduced resource utilization including length of hospital stay and use of blood products. As the appropriate candidates become elucidated, robotic assistance may improve the safety and cost-effectiveness of reoperative LVAD surgery.
From the *Department of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona; †Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; ‡Division of Cardiology, Department of Internal Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona; §Department of Physiological Sciences, University of Arizona, Tucson, Arizona; ¶Department of Internal Medicine, University of Arizona, Tucson, Arizona; ‖Department of Cardiac Surgery CPE Institute of Cardiology, Multan, Pakistan; #Department of Anesthesia, University of Arizona, Tucson, Arizona; and **Department of Biomedical Engineering, University of Arizona, Tucson, Arizona.
Zain
Z
Khalpey
Irbaz
I
Bin Riaz
Katherine M
KM
Marsh
Muhammad Zubair Ahmad
MZ
Ansari
Jawad
J
Bilal
Anthony
A
Cooper
Samata
S
Paidy
Jan D
JD
Schmitto
Richard
R
Smith
Mark
M
Friedman
Marvin J
MJ
Slepian
Robert
R
Poston
D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D012086:Reoperation; D065287:Robotic Surgical Procedures; D056346:Sternotomy; D013908:Thoracotomy / Q000379:methods