Three Years Experience With Minimally Invasive Lvad Implantantion
Vladimir Horvath, Tomas Ostrizek, Jiri Ondrasek, Petr Fila, Helena Bedanova, Robert Wagner, Petr Nemec.
Center for Cardiovascular and Transplant Surgery, Brno, Czech Republic.
OBJECTIVE: Left ventricular assist device (LVAD) as a bridge to transplant strategy is well established. However, the implantation of LVAD is invasive and associated with significant peri-operative complications in these critically ill patients. Lower invasiveness of implantation might have the potential to enhance results of these high risk patients The aim of this study is to present our three years experience with minimally invasive approach to implantation of left ventricular assist device HeartWare HVAD.
METHODS: Twenty nine patients underwent minimally invasive implantation of left ventricular assist device Heartware HVAD between November 2013 and December 2016 as a bridge to heart transplantation in our centre. Twenty eight patients were males, one patient was female. Mean age of patients was 54 ± 9,8 years. Basic diseases were dilated cardiomyopathy in 16 patients (55%), ischemic cardiomyopathy in 4 patients (38%) and hypertrophic cardiomyopathy in 2 patients (7% ). The mean value of left ventricular ejection fraction was 14,2 ± 4,2%, right ventricular ejection fraction was 30,9 ± 5.4%. Access to the left ventricular apex was reached by small left anterior thoracotomy (approximately 8 cm incision ). To access the ascending aorta we used upper J ministernotomy.
RESULTS: Minimally invasive implantation was successful in all patients. In one patient closure of foramen ovale was simultaneously performed. Most patients (79%) were extubated on the first postoperative day. Only in two cases (7% ) a failure of the right ventricle occurred with the need for temporary percutaneous right-sided circulatory support device Centrimag. Overall thirty-day survival was 94 %, one year survival was 76%. Fourteen patients (48%) underwent successfully heart transplantation, eight patients (28%) remain on LVAD support.
CONCLUSIONS: Minimally invasive LVAD implantation is feasible, safe and allows easier re-entry for subsequent transplantation. There is also a promising tendency for lower incidence of perioperative right heart failure. After initial experience with this technique it has become the method of choice in our centre.
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