In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device

Bantayehu Sileshi, Nicholas A. Haglund, Mary E. Davis, Nicole M. Tricarico, John M. Stulak, Zain I Khalpey, Matthew R. Danter, Robert Deegan, Jason Kennedy, Mary E. Keebler, Simon Maltais

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.

Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.

Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.

Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

Original languageEnglish (US)
Pages (from-to)107-112
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2015

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Heart-Assist Devices
Thoracotomy
Length of Stay
Propensity Score
Sternotomy
Hospital Mortality
Artificial Respiration
Intensive Care Units
Multivariate Analysis

Keywords

  • heart failure
  • left thoracotomy
  • left ventricular assist device
  • off-pump surgery
  • peri-operative outcomes
  • surgical approach

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device. / Sileshi, Bantayehu; Haglund, Nicholas A.; Davis, Mary E.; Tricarico, Nicole M.; Stulak, John M.; Khalpey, Zain I; Danter, Matthew R.; Deegan, Robert; Kennedy, Jason; Keebler, Mary E.; Maltais, Simon.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 1, 01.01.2015, p. 107-112.

Research output: Contribution to journalArticle

Sileshi, B, Haglund, NA, Davis, ME, Tricarico, NM, Stulak, JM, Khalpey, ZI, Danter, MR, Deegan, R, Kennedy, J, Keebler, ME & Maltais, S 2015, 'In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device', Journal of Heart and Lung Transplantation, vol. 34, no. 1, pp. 107-112. https://doi.org/10.1016/j.healun.2014.09.023
Sileshi, Bantayehu ; Haglund, Nicholas A. ; Davis, Mary E. ; Tricarico, Nicole M. ; Stulak, John M. ; Khalpey, Zain I ; Danter, Matthew R. ; Deegan, Robert ; Kennedy, Jason ; Keebler, Mary E. ; Maltais, Simon. / In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 1. pp. 107-112.
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abstract = "Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8{\%}. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.",
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T1 - In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device

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AU - Haglund, Nicholas A.

AU - Davis, Mary E.

AU - Tricarico, Nicole M.

AU - Stulak, John M.

AU - Khalpey, Zain I

AU - Danter, Matthew R.

AU - Deegan, Robert

AU - Kennedy, Jason

AU - Keebler, Mary E.

AU - Maltais, Simon

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N2 - Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

AB - Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

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