Thorac Cardiovasc Surg 2019; 67(03): 170-175
DOI: 10.1055/s-0038-1649493
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation – A Single-Center Experience

D. Reichart
1  Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
C.F. Brand
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
A.M. Bernhardt
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
S. Schmidt
1  Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
A. Schaefer
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
S. Blankenberg
1  Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
H. Reichenspurner
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
F.M. Wagner
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
T. Deuse
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
,
M.J. Barten
2  Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

26 December 2017

26 March 2018

Publication Date:
27 May 2018 (online)

Abstract

Background Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group).

Methods HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed.

Results No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48).

Conclusion The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.