Left Lateral Thoracotomy for Centrifugal Continuous-Flow Left Ventricular Assist Device Placement

An Analysis from the Mechanical Circulatory Support Research Network

Simon Maltais, Lucman A. Anwer, Vakhtang Tchantchaleishvili, Nicholas A. Haglund, Shannon M. Dunlay, Keith D. Aaronson, Francis D. Pagani, Jennifer Cowger, Christopher T. Salerno, Palak Shah, Zain I Khalpey, Jan Schmitto, John M. Stulak

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Continuous-flow left ventricular assist devices (CF-LVADs) have revolutionized the management of patients with advanced heart failure. Alternative implant strategies are increasingly used for device placement. We reviewed our experience from the Mechanical Circulatory Support Research Network registry with the HeartWare centrifugal CF-LVAD (HVAD). From May 2004 to August 2015, 1,150 patients underwent primary CF-LVAD implantation at our institutions. Within this group, a total of 283 patients (25%) were implanted with the HVAD. A minimally invasive left lateral thoracotomy (MILT) implant strategy was used in 53 patients (20%), of which 22 (42%) were implanted off-pump. Median age at implant was 59 years and 183 patients (65%) were implanted as bridge-to-transplantation. Follow-up was 100% complete for a total of 302 patient-years of support. In-hospital mortality was 4.9% (14 patients), and was comparable between the conventional sternotomy (CS) and MILT cohorts (p = 0.15). Patients in the MILT cohort had a shorter median length of stay (p < 0.01) and had a lower incidence of postimplant pump thrombus (p = 0.02). Cumulative survival at the end of follow-up reached 84%, and was comparable between the two groups (p = 0.298). Multivariate analysis identified preoperative bilirubin level as the only independent predictor of survival. Surgical technique had no impact on survival. In this large, multicenter experience, data demonstrate excellent survival and adverse event profiles for patients supported with the HVAD technology, regardless of surgical implant technique. With constant advancements in device technology along with our increasing clinical experience with the newer techniques, minimally invasive LVAD implantation continues to evolve as a valuable alternative to CS in selected patients.

Original languageEnglish (US)
Pages (from-to)715-720
Number of pages6
JournalASAIO journal (American Society for Artificial Internal Organs : 1992)
Volume64
Issue number6
DOIs
StatePublished - Nov 1 2018

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Left ventricular assist devices
Heart-Assist Devices
Thoracotomy
Research
Pumps
Bilirubin
Sternotomy
Survival
Technology
Equipment and Supplies
Hospital Mortality
Registries
Length of Stay
Thrombosis
Multivariate Analysis
Heart Failure
Transplantation

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Left Lateral Thoracotomy for Centrifugal Continuous-Flow Left Ventricular Assist Device Placement : An Analysis from the Mechanical Circulatory Support Research Network. / Maltais, Simon; Anwer, Lucman A.; Tchantchaleishvili, Vakhtang; Haglund, Nicholas A.; Dunlay, Shannon M.; Aaronson, Keith D.; Pagani, Francis D.; Cowger, Jennifer; Salerno, Christopher T.; Shah, Palak; Khalpey, Zain I; Schmitto, Jan; Stulak, John M.

In: ASAIO journal (American Society for Artificial Internal Organs : 1992), Vol. 64, No. 6, 01.11.2018, p. 715-720.

Research output: Contribution to journalArticle

Maltais, S, Anwer, LA, Tchantchaleishvili, V, Haglund, NA, Dunlay, SM, Aaronson, KD, Pagani, FD, Cowger, J, Salerno, CT, Shah, P, Khalpey, ZI, Schmitto, J & Stulak, JM 2018, 'Left Lateral Thoracotomy for Centrifugal Continuous-Flow Left Ventricular Assist Device Placement: An Analysis from the Mechanical Circulatory Support Research Network', ASAIO journal (American Society for Artificial Internal Organs : 1992), vol. 64, no. 6, pp. 715-720. https://doi.org/10.1097/MAT.0000000000000714
Maltais, Simon ; Anwer, Lucman A. ; Tchantchaleishvili, Vakhtang ; Haglund, Nicholas A. ; Dunlay, Shannon M. ; Aaronson, Keith D. ; Pagani, Francis D. ; Cowger, Jennifer ; Salerno, Christopher T. ; Shah, Palak ; Khalpey, Zain I ; Schmitto, Jan ; Stulak, John M. / Left Lateral Thoracotomy for Centrifugal Continuous-Flow Left Ventricular Assist Device Placement : An Analysis from the Mechanical Circulatory Support Research Network. In: ASAIO journal (American Society for Artificial Internal Organs : 1992). 2018 ; Vol. 64, No. 6. pp. 715-720.
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