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Single Center Experience with 52 Less Invasive Left Ventricular Assist Device Implantations
Abstracts Purpose: To investigate the impact of previous sternotomy after cardiac surgery on the outcome of three different continuous flow left ventricular assist devices (cfLVAD): HeartMate II (HMII), HeartMate III (HMIII) and HeartWare (HVAD). There are only a few studies with a small number of patients available, aimed at this topic. Methods: Between June 2007 and February 2018, a total of 121 patients received HMII, n = 73 (60.3%), HVAD, n = 15 (12.4%), or HM III, n = 33 (27.3%), with or without previous sternotomy (PS and non-PS groups, respectively). Propensity matching resulted in 44 patient pairs. The primary endpoint was overall survival at 30 days, one year, two and five years after device implantation. Secondary endpoints were adverse events and other postoperative characteristics during the follow-up period. Results: The overall cumulative survival rates for the two study groups at 30 days, one year, two and five years were significantly different (77%, 63%, 54% and 38% for non-PS group vs. 64%, 39%, 27% and 24% for PS group, p = 0.036). In the PS group there was a higher need for intraoperative implantation of short-term right ventricular assist device (22.7% vs. 6.8%, p = 0.034) and a higher incidence of hepatic dysfunction (20.5 vs. 4.5%, p = 0.025) and acute kidney dysfunction (40.9% vs. 20.5%, p = 0.032). Previous sternotomy was a reliable predictor of in-hospital (OR = 2.580, 95%CI = 1.306 - 6.218) and overall mortality (OR = 1.879, 95%CI = 1.172 - 3.013). Conclusion: Previous sternotomy is a reliable predictor of mortality after cfLVAD implantation and represents an independent risk factor for other major and minor complications.
S369 gastrointestinal bleed, bacteremia, anemia and syncope. Ninety-day survival was 26/28 (93%). Conclusion: In our single center experience, two thirds of patients were discharged home after HeartMate 3 implantation using less invasive surgical techniques. Along with short hospital stays, we observed a low 90-day readmission rate. Multicenter studies are required to further validate the benefits of less invasive HeartMate 3 implantation. 929 Single Center Experience with 52 Less Invasive Left Ventricular Assist Device Implantations F. Sipahi, A. Mehdiani, A. Albert, H. Aubin, U. Boeken, P. Akhyari, R. Westenfeld, A. Lichtenberg and D. Saeed. Cardiovascular Surgery, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany. Purpose: Avoiding full sternotomy may reduce the invasiveness of left ventricular assistdevice (LVAD) implantation. Less invasive LVAD implantation was implemented at our center few years ago. We aim to present our experience with this surgical approach in 52 consecutive patients. Methods: This is a single center retrospective observational study based on a prospectively collected VAD database. Inclusion criteria were patients supported with LVAD between January 2014 and August 2018 using minimal invasive approach. The J Sternotomy and anterolateral thoracotomy was used in every patient. A total of 52 patients (mean age 60 § 10 years; male 88%; redo surgery 23%; INTERMACS level 3 § 1; preoperative short term circulatory support 10%) underwent minimally invasiveLVAD (25 HeartWare HVAD and 27 HeartMate III) implantation at our department. Implantation aim was destination therapy in 44%. Off-Pump implantation was used in 15%. Results: The minimally invasive approach was feasible in all patients with no n eed for conversion to full sternotomy. Hemodynamic data prior to and after VAD implanttain is presented in table 1. Revision for bleeding was necessary in 2 patients (4%). Right ventricular failure requiring right VAD was necessary in 11%. Stroke rate of 13% and drive-line infection of 10%was recorded after mean support duration of 331 days (5-1013 days). Heart transplantation was performed in 19%. Thirty-day and 1 year survival was 94 and 75%, respectively . Conclusion: Less invasive implantation of LVAD is feasible and safe. The feasibility of less invasive implantation is not limited to HeartWare HVAD. This study includes the largest reported series of less invasive HeartMate III implantation as well. The encouraging results obtained in this series may justify a broader application of this technique.
928 Get Home, Stay Home: 90-Day Readmission Rate after Complete Sternal-Sparing HeartMate3 Implantation K. Wood, B.C. Ayers, H. Vidula, J. Alexis, J. Delehanty, B. Barrus, P. Knight, L. Chen, S. Prasad and I. Gosev University of Rochester, Rochester, NY. Purpose: The purpose of this study was to evaluate discharge patterns, days spent out of hospital and 90-day readmission rates after utilizing the complete sternal-sparing technique for HeartMate3 implantation. Methods: Retrospective analysis of prospectively collected data was performed on 36 consecutive patients implanted with left ventricular assist devices between February and July 2018 at a single institution. Patients were excluded if they were enrolled in a study requiring full sternotomy (1 patient), were a pump exchange (5 patients), or were implanted with the HeartWare device (2 patients). Results: A total of 28 patients were included in the study, all of which underwent complete sternal-sparing HeartMate 3 implantation. Two patients died during the initial hospitalization. Average age was 56.0§ 11.7 years, 77% were male and 50% were INTERMACS Profile 1. Intensive care unit and hospital length of stay were 4.5 days (IQR=2-7 days) and 15 days (IQR=12-31days), respectively. Seventeen patients (65%) were discharged home, and nine patients (35%) were discharged to acute rehab. After hospital discharge, patients spent 97% of their time out of the hospital. Three patients (12%) were readmitted to the hospital, one of whom was readmitted twice. Reasons for readmissions included
930 Experience with Long-Term Contiunous Flow Ventricular Assist Deviceas Bridge to Recovery Concept R. Wieloch, A. Albert, A. Mehdiani, U. Boeken, H. Aubin, R. Westenfeld, P. Akhyari, A. Lichtenberg and D. Saeed. Cardiovascular Surgery, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany. Purpose: In the era of continuous flow ventricular assist devices (VAD) only minority of patients can be considered for cardiac recovery and device explantation. The purpose of this study is to report our experience with several techniques of VAD deactivation/explantation. Methods: This is a single center, observational study based on a prospectively collected data. Inclusion criteria were patients supported with Left VAD (LVAD) between 01.2010 and 09.2018. Routine echocardiography examinations were performed after VAD implantation.
S369 gastrointestinal bleed, bacteremia, anemia and syncope. Ninety-day survival was 26/28 (93%). Conclusion: In our single center experience, two thirds of patients were discharged home after HeartMate 3 implantation using less invasive surgical techniques. Along with short hospital stays, we observed a low 90-day readmission rate. Multicenter studies are required to further validate the benefits of less invasive HeartMate 3 implantation. 929 Single Center Experience with 52 Less Invasive Left Ventricular Assist Device Implantations F. Sipahi, A. Mehdiani, A. Albert, H. Aubin, U. Boeken, P. Akhyari, R. Westenfeld, A. Lichtenberg and D. Saeed. Cardiovascular Surgery, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany. Purpose: Avoiding full sternotomy may reduce the invasiveness of left ventricular assistdevice (LVAD) implantation. Less invasive LVAD implantation was implemented at our center few years ago. We aim to present our experience with this surgical approach in 52 consecutive patients. Methods: This is a single center retrospective observational study based on a prospectively collected VAD database. Inclusion criteria were patients supported with LVAD between January 2014 and August 2018 using minimal invasive approach. The J Sternotomy and anterolateral thoracotomy was used in every patient. A total of 52 patients (mean age 60 § 10 years; male 88%; redo surgery 23%; INTERMACS level 3 § 1; preoperative short term circulatory support 10%) underwent minimally invasiveLVAD (25 HeartWare HVAD and 27 HeartMate III) implantation at our department. Implantation aim was destination therapy in 44%. Off-Pump implantation was used in 15%. Results: The minimally invasive approach was feasible in all patients with no n eed for conversion to full sternotomy. Hemodynamic data prior to and after VAD implanttain is presented in table 1. Revision for bleeding was necessary in 2 patients (4%). Right ventricular failure requiring right VAD was necessary in 11%. Stroke rate of 13% and drive-line infection of 10%was recorded after mean support duration of 331 days (5-1013 days). Heart transplantation was performed in 19%. Thirty-day and 1 year survival was 94 and 75%, respectively . Conclusion: Less invasive implantation of LVAD is feasible and safe. The feasibility of less invasive implantation is not limited to HeartWare HVAD. This study includes the largest reported series of less invasive HeartMate III implantation as well. The encouraging results obtained in this series may justify a broader application of this technique.
928 Get Home, Stay Home: 90-Day Readmission Rate after Complete Sternal-Sparing HeartMate3 Implantation K. Wood, B.C. Ayers, H. Vidula, J. Alexis, J. Delehanty, B. Barrus, P. Knight, L. Chen, S. Prasad and I. Gosev University of Rochester, Rochester, NY. Purpose: The purpose of this study was to evaluate discharge patterns, days spent out of hospital and 90-day readmission rates after utilizing the complete sternal-sparing technique for HeartMate3 implantation. Methods: Retrospective analysis of prospectively collected data was performed on 36 consecutive patients implanted with left ventricular assist devices between February and July 2018 at a single institution. Patients were excluded if they were enrolled in a study requiring full sternotomy (1 patient), were a pump exchange (5 patients), or were implanted with the HeartWare device (2 patients). Results: A total of 28 patients were included in the study, all of which underwent complete sternal-sparing HeartMate 3 implantation. Two patients died during the initial hospitalization. Average age was 56.0§ 11.7 years, 77% were male and 50% were INTERMACS Profile 1. Intensive care unit and hospital length of stay were 4.5 days (IQR=2-7 days) and 15 days (IQR=12-31days), respectively. Seventeen patients (65%) were discharged home, and nine patients (35%) were discharged to acute rehab. After hospital discharge, patients spent 97% of their time out of the hospital. Three patients (12%) were readmitted to the hospital, one of whom was readmitted twice. Reasons for readmissions included
930 Experience with Long-Term Contiunous Flow Ventricular Assist Deviceas Bridge to Recovery Concept R. Wieloch, A. Albert, A. Mehdiani, U. Boeken, H. Aubin, R. Westenfeld, P. Akhyari, A. Lichtenberg and D. Saeed. Cardiovascular Surgery, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany. Purpose: In the era of continuous flow ventricular assist devices (VAD) only minority of patients can be considered for cardiac recovery and device explantation. The purpose of this study is to report our experience with several techniques of VAD deactivation/explantation. Methods: This is a single center, observational study based on a prospectively collected data. Inclusion criteria were patients supported with Left VAD (LVAD) between 01.2010 and 09.2018. Routine echocardiography examinations were performed after VAD implantation.