Minimally Invasive Implantation Of Left Ventricular Assist Devices Safe Implementation Early In A Surgical Career
Hannah J. Voorhees, Erik N. Sorensen, PhD, Chetan Pasrija, MD, Francesca Boulos, Si M. Pham, MD, Bartley P. Griffith, MD, Zachary N. Kon, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
OBJECTIVE: Several centers have presented minimally invasive surgical approaches to centrifugal left ventricular assist device (LVAD) implantation. While these large implanting centers have found minimally invasive implantation can be successfully performed by experienced surgeons, it is unknown whether these techniques are widely adoptable. We compared conventional and minimally invasive surgical approaches when performed by a surgeon early in his career.
METHODS: All consecutive LVAD implantations by a single surgeon in his first year of practice (2015-2016) were retrospectively reviewed. Patients were stratified by standard approach, conventional full sternotomy (CS), versus a minimally invasive approach, left anterior thoracotomy and upper hemisternotomy (LTHS). Demographic, perioperative variables, and short term outcomes were compared.
RESULTS: Thirteen patients were identified (CS=6, LTHS=7). Preoperative age, INTERMACS score, creatinine, and total bilirubin were comparable in the CS and LTHS groups with significantly more preoperative RV dysfunction in the LTHS group (p=0.01). Operative time was significantly shorter (p=0.02) in CS compared to LTHS, but cardiopulmonary bypass time trended towards statistically shorter times in the LTHS group. One LTHS patient was converted to a full sternotomy due to intraoperative bleeding, but no patients in either group required a right ventricular assist device (RVAD). Although not statistically significant, ICU length of stay (LOS) and hospital LOS were also nominally reduced in LTHS implants. Six-month survival in both groups was 100%.
CONCLUSIONS: In this small series, LTHS appears at least comparable if not superior to CS in regards to perioperative outcomes. Although operative time was longer in LTHS, this was still within the learning curve of a surgeon’s initial experience. Overall, this minimally invasive approach appears to be safe and efficacious and adoptable by surgeons early in their careers.
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