Is It Possible To Implant Heartmate 3 Less Invasively? New Pump, New Approach
Sinan Sabit Kocabeyoglu1, Umit Kervan1, Dogan Emre Sert1, Burcu Demirkan2, Yesim Akin2, Emre Aygun1, Osman Fehmi Beyazal1, Mehmet Karahan1, Mustafa Pac1.
1Turkiye Yuksek Ihtisas Hospital, Cardiovascular Surgery, Ankara, Turkey, 2Turkiye Yuksek Ihtisas Hospital, Cardiology, Ankara, Turkey.
OBJECTIVE: The Thoratec® HeartMate 3 (HM3) ventricular assist device (VAD) is a new compact, intrapericardial, centrifugal flow pump with a full magnetically levitated rotor and a wide range of operation (2-10 L/min) to accommodate a broad range of clinical needs. We analyzed our experience Heartware®VAD (HVAD) and HM3 VAD implantation through minimally invasive left thoracotomy (MILT) and J sternotomy implantation techniques.
METHODS: Between March 2015 and October 2016, 31 patients who underwent VAD implantation through MILT were included in this study. Twenty-three patients had HVAD (group A) implantation, whereas eight patients had HM3 (group B). To compare outcomes of these pumps measures were; the length of intubation, hemolysis, blood loss and transfusion rate, length of intensive care unit (ICU) and hospital stay, right ventricular failure and requirement support with devices, stroke, pump thrombosis, bleeding and in hospital driveline infection rates.
RESULTS: There was no difference in the length of ICU stay (p=0,22), post-operative blood product administration (p=0,11) and total time on mechanical ventilation (p=0,46), RVF (p=0,76), duration of cardiopulmonary bypass (p=0,32). After adjusting for age, INTERMACS profile and Pennsylvania and Michigan Risk Scores, right ventricular stroke work index and central venous pressure/pulmonary capillary wedge pressure (CVP/PCWP) ratio did not differ between these two groups. In-hospital cerebrovascular event rate was 13% in group A and 0% in group B, respectively.
CONCLUSIONS: The HM3 assist system with full MagLev technology that enables rapid speed changes and allows to develop an artificial pulsatile flow, can be successfully implanted with MILT techniques. This technique has proved to be safe and reproducible, with good clinical outcome. Further large collaborative studies are needed to identify advantages of the this approach.
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