title: Outcomes of Patients Implanted Using a Left Thoracotomy Technique for a Miniaturized Centrifugal Continuous-Flow Pump.
abstract: As ventricular-assist devices (VADs) are increasingly employed in heart failure management, a leading cause of mortality, new literature is consistently published on less-invasive implantation techniques. Although early perioperative outcomes have been shown to be favorable with minimally invasive left thoracotomy (LT) approaches compared with conventional sternotomy (CS), studies comparing long-term outcomes are lacking. We set out to evaluate long-term follow up between LT and CS approach. In a single center, retrospective review, data on patients with similar demographic profiles were collected. HeartWare (HVAD) implantation was performed by either CS or LT. Analysis was performed on perioperative adverse outcomes, and 6 month postoperative adverse events. Primary objectives of the study included comparative outcomes of morbidity and mortality between both groups at 180 days postimplantation. Eighty-one (n = 81) bridge to transplant (BTT) patients underwent CS or LT HVAD implantation. Perioperative transfusion (p = 0.04) favored the LT cohort compared with CS, with a median of 6 units and 8 units transfused for each group, respectively. No survival difference was observed between both groups at 6 months postimplantation (p = 0.52). Clinical outcomes at an average of 6 month follow up showed no difference in adverse events, including common postoperative VAD complications such as infection and right heart failure. Miniaturization of LVAD size and improvement in technology has allowed expansion of interest in alternative surgical approaches for HVAD implantation. For BTT patients, no difference in early outcome was observed 6 months after implantation using a left LT versus CS technique.
authors.affiliation: From the *Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; †Department of Surgery, Duke University Medical Center, Durham, North Carolina; ‡Department of Cardiology, §Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and ¶Departments of Cardiothoracic Surgery and Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota.
authors.forename: Bantayehu
authors.initials: B
authors.lastname: Sileshi
authors.forename: Brian K
authors.initials: BK
authors.lastname: O'Hara
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.forename: Xu
authors.initials: X
authors.lastname: Meng
authors.forename: Robert
authors.initials: R
authors.lastname: Deegan
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: Andrew
authors.initials: A
authors.lastname: Shaw
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods / Q000401:mortality; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome