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- Title
Initial experience with routine less invasive implantation of HeartMate II left ventricular assist device without median sternotomy.
- Authors
Anyanwu, Anelechi C.; Itagaki, Shinobu; Pinney, Sean; Adams, David H.
- Abstract
OBJECTIVES Standard implantation of HeartMate II (HMII) left ventricular assist device requires an extended median sternotomy; this incision, while generally well tolerated, may add morbidity in critically ill debilitated patients. We recently adopted a sternum sparing technique for routine HMII implants using a left subcostal incision to create a pocket and access the left ventricular apex, and a right minithoracotomy to access the ascending aorta. METHODS Retrospective analysis of 40 consecutive patients (M:F 32 : 8; age range 48–77 years; Interagency Registry for Mechanically Assisted Circulatory Support 1 = 8; 2 = 10; 3 or 4 = 22) who underwent implantation of HMII using a non-sternotomy approach in a single institution. RESULTS HMII insertion was completed with the less invasive technique in all cases with no conversions to full sternotomy. There were no reoperations for bleeding and 70% of patients did not have any intraoperative blood product transfusion. No patient required right ventricular assist device support. Majority of patients (80%) were extubated by postoperative day 1. There were no wound, mediastinal or pocket infections. One patient suffered a new perioperative stroke. Median postoperative hospital stay was 19 days. Operative mortality was 7.5% and 12-month actuarial survival was 86 ± 6%. CONCLUSIONS Primary HMII implantation without median sternotomy is feasible and can be safely, effectively and routinely applied, using our less invasive approach. Further investigation is necessary to determine whether the non-invasive technique contributed to the low incidence of bleeding, blood transfusion, respiratory morbidity and right ventricular failure seen in this study.
- Subjects
LEFT heart ventricle; HEART assist devices; CARDIAC surgery; CARDIAC patients; BLOOD transfusion
- Publication
European Journal of Cardio-Thoracic Surgery, 2014, Vol 46, Issue 6, p985
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezu044