title: Subxiphoid Exchange of HeartMate II Left Ventricular Assist Device.
abstract: With increasing use of left ventricular assist devices (LVADs) for long-term circulatory support comes a growing need for device exchange. The conventional surgical approach for device exchanges has been a reoperative median resternotomy. Less-invasive HeartMate II LVAD exchange via a nonmuscle-dividing subxiphoid incision as an alternative to a left subcostal incision may reduce pain burden and facilitate recovery. From November 2006 to June 2015, 292 patients underwent HeartMate II LVAD placement, of which 30 (10.3%) required an exchange. Twenty-four (80%) LVAD exchanges were performed through a subxiphoid sternal-sparing approach and six (20%) through reoperative sternotomy. Predominant indication for device exchange was suspected or confirmed pump thrombus (73.3%), followed by electromechanical pump dysfunction (16.7%). The subxiphoid approach resulted in significantly shorter median intensive care unit (7 vs. 37 days, p = 0.01) and hospital stay (29 vs. 107 days, p = 0.01) compared with reoperative sternotomy. Kaplan-Meier analysis showed comparable survival between the subgroups (p = 0.15) as well as between the patients with device exchange and the rest of the HeartMate II LVAD patients at our institution (p = 0.12). Subxiphoid device exchange is a viable option, resulting in low operative morbidity and mortality with no adverse effect on late survival.
authors.affiliation: From the *Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York; †Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; and ‡Department of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Vakhtang
authors.initials: V
authors.lastname: Tchantchaleishvili
authors.forename: Jessica G Y
authors.initials: JGY
authors.lastname: Luc
authors.forename: Joshua
authors.initials: J
authors.lastname: Haswell
authors.forename: William
authors.initials: W
authors.lastname: Hallian
authors.forename: H Todd
authors.initials: HT
authors.lastname: Massey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods