Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1679026
Short Presentations
Tuesday, February 19, 2019
DGTHG: Auf den Punkt gebracht – End-stage Heart Failure und Assist Devices
Georg Thieme Verlag KG Stuttgart · New York

Alternative Outflow Graft Placement during Thoracotomy Implant of the HVAD System for the Treatment of Advanced Heart Failure

D. J. Schmitto
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
G. Dogan
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
S. J. Hanke
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
J. Riebandt
2   Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
M. Ozbaran
3   Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
,
C. Engin
3   Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
,
U. Kervan
4   Department of Heart Transplantation, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
,
M. Paç
4   Department of Heart Transplantation, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
,
V. Horvath
5   Center of Cardiovascular and Transplant Surgery, Brno, Czech Republic
,
S. Klotz
6   Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Luebeck, Lübeck, Germany
,
F. Wagner
7   Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
,
C. J. Roussel
8   Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Saint-Herblain, France
,
M. Shrestha
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
C. Feldmann
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
A. Chatterjee
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
A. Martens
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
D. Zimpfer
2   Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

 
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    Objectives: Thoracotomy-based HVAD implantation is now commonly used for advanced heart failure treatment. Certain patient physiologies or co-morbidities allow alternative outflow graft placement locations when the ascending aorta is not a viable option. The objective of this study was to evaluate multicenter data of HVAD implantation with alternative outflow graft placement.

    Methods: Retrospective data was analyzed from 95 patients implanted with the HVAD via thoracotomy approach between March, 2012 and September, 2017 at 8 clinical centers. Survival was assessed with Kaplan Meier methodology. Descriptive statistics were applied to describe patient characteristics, adverse event profiles and outcomes. Comparisons were made to analyze any difference in outcomes between on or off-pump implantation, as well as between outflow graft placements in the descending aorta (DA) versus subclavian artery (SA).

    Results: The overall average age of patients receiving HVAD implantation was 59.5 ± 8.72 years. Patients with outflow graft placement in the DA and the SA were 29.5 and 69.5%, respectively. 365- and 730-day outcomes of HVAD implantation were 71.2 and 60.8%, respectively.

    180 and 365 day outcomes of on-pump implantation were 74.7 and 69.9%, respectively, while 180- and 365-day outcomes of off-pump implantation were 80.5 and 73.2%, respectively. Driveline infection was 8.4, 3.8, and 14.3% overall, on-pump, and off-pump implantation, respectively. Right heart failure was 15.8, 7.5, and 26.2% overall, on-pump, and off-pump implantation, respectively.

    Driveline infection for outflow graft placement in DA and SA were 0 and 28.6%, respectively. Right heart failure for outflow graft placement in DA and SA were 16.7 and 14.3%, respectively.

    Conclusions: This analysis represents the largest retrospective review of HVAD implantation via a thoracotomy approach with alternative outflow graft implant approaches. When implantation was performed off-cardiopulmonary bypass (off-pump), the incidence of adverse events is similar to on-pump, although there was more right heart failure during follow-up. However, overall survival was similar for on- or off-pump implantation. Outflow graft placement in the SA showed higher infection rates, despite similar survival rates to descending aorta placement.


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    No conflict of interest has been declared by the author(s).

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