In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device
Section snippets
Study design
Our investigation was a retrospective analysis of prospectively gathered data from January 2013 to February 2014. The study was approved by the institutional review board of the Vanderbilt University Medical Center. Patients were invividually consented for the surgical approach utilized and agreed to move forward with the proposed implant technique despite the investigational nature of the off-pump left thoracotomy strategy. For all patients in the conventional surgery group (CS group), a
Results
Between January 2013 and February 2014, 51 patients were found to meet our study inclusion criteria and underwent HVAD implantation. Thirty-three patients (26 men, or 79%) had a CS implant, whereas 18 (12 men, or 72%) were approached using a MILT. All patients were implanted for a bridge-to-transplantation indication. Median age at implant was 57 (range 18 to 69) years. The two groups were similar in pre-operative characteristics, including INTERMACS profile and Kormos and LM scores (Table 1).
Discussion
Ventricular assist device surgery has become an integral procedure for the treatment of terminal heart failure.11 HVADs, approved by the U.S. Food and Drug Administration in November 2012 for bridge-to-transplant indications, have been used with greater frequency, with more than 2,500 pumps placed worldwide.12 The surgical approach for HVAD placement has tradionally been a mid-line sternotomy using CPB.10 Although this approach has been successful, it may increase the risk of post-operative
Disclosure statement
D.M. is a paid consultant for HeartWare. The remaining authors have no conflicts of interest to disclose. We thank Dr Martin Strüber (Leipzig, Germany) and Dr Jan Schmitto (Hannover, Germany) for allowing us to visit their centers and develop our strategy for MILT HVAD implantation.
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