title: Clinical Experience With Sternotomy Versus Subcostal Approach for Exchange of HeartMate II Left Ventricular Assist Device.
abstract: BACKGROUND
  The safety and efficacy of exchanging the HeartMate II (Thoratec Corp, Pleasanton, CA) left ventricular assist device (LVAD) through a less invasive subcostal approach remains unclear.
  
  
  METHODS
  We reviewed the records of 17 patients who underwent exchange of their HeartMate II device at our institution since 2007. We divided the cohort into devices exchanged through a subcostal (SC) approach versus a median sternotomy (MS) approach and obtained data pertaining to the short- and long-term outcomes.
  
  
  RESULTS
  Nine patients had pump exchange through an MS approach versus 8 patients who underwent an SC approach. The mean duration of support with the first pump was 540 ± 450 days. The reason for exchange was electromechanical failure (7 patients), thrombosis (8 patients), and infection (2 patients). There were no 30-day perioperative deaths with either approach. Compared with sternotomy, patients who underwent an SC approach had significantly shorter operative times (131 vs 222 minutes; p = 0.001) and lower reoperation rates for bleeding (0 vs 44.4%; P = 0.05) and required fewer transfused blood products (packed red cells, 3.5 units vs 7.1 units; p < 0.05; cryoprecipitate, 50.7 mL vs 209.3 mL; p = 0.01; and platelets, 292 mL versus 762 mL; p < 0.05). Additionally, patients who underwent an SC approach had shorter postoperative stays in the intensive care unit (ICU) (5 days vs 13.8 days; p < 0.05) and shorter total hospital stays (16.4 days vs 27.2 days; p < 0.05). Long-term survival after mean follow-up of 260 days for the SC group and 232 days for the sternotomy group was 75% and 33%, respectively.
  
  
  CONCLUSIONS
  Exchange of the HeartMate II pump can be accomplished with low morbidity and mortality and good long-term outcomes through a less invasive SC approach.
authors.affiliation: Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: bsoleimani@hmc.psu.edu.
authors.forename: Behzad
authors.initials: B
authors.lastname: Soleimani
authors.affiliation: Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Stephenson
authors.affiliation: Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Price
authors.affiliation: Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Aly
authors.initials: A
authors.lastname: El-Banayosy
authors.affiliation: Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pae
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013997:Time Factors