InnovationA minimally invasive off-pump implantation technique for continuous-flow left ventricular assist devices: Early experience
Section snippets
Patients
After informed consent of the patients, data of 26 patients who underwent implantation of an HVAD System as an LVAD since June 2012 were analyzed in a prospective manner.
Inclusion criteria
The analysis included patients who fulfilled Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) categories 2 and 3 after evaluation and hemodynamic stabilization. The surgery was scheduled as an elective procedure so that informed consent for the procedure could be obtained.
Exclusion criteria
The analysis excluded
Results
Ann off-pump thoracotomy approach was used to perform 26 consecutive HVAD implants from June 2012 to April 2013. The overall number of isolated LVAD procedures at that time was 43. Baseline data for the 26 patients are presented in Table 1. Seven patients had undergone prior cardiac surgery, of whom 4 had undergone prior revascularizations, with mostly patent grafts, and the remaining 3 had undergone mitral valve surgery. All patients fit INTERMACS criteria 2 or 3.
Table 2, Table 3 report the
Discussion
This analysis demonstrates the safety and feasibility of implantation of the HeartWare System as an LVAD by the off-pump thoracotomy approach. Despite the limited viewing field, there are no problems with proper placement of the inflow at the apex. Still, care must be taken to ensure an appropriate size of the thoracotomy to allow rapid insertion of the HVAD into the ventricle. The use of advanced imaging modalities, such as 3D Echo, to visualize possible thrombus and
pump placement is the key
Disclosure statement
The authors thank Mary V. Jacoski, of HeartWare Inc, for editorial support in the preparation of this manuscript.
Martin Strueber, MD, was a primary investigator in the HeartWare HVAD trial and is an expert consultant for HeartWare Inc. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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