Outcomes of Minimally Invasive vs. Conventional Implantation of Continuous Flow Left Ventricualr Assist Device: A Single Center Experience

Abstract

Purpose The use of left ventricular assist device (LVAD) as a bridge to transplant and for destination therapy is increasing. Conventional LVAD implantation (CON) is performed using a midline sternotomy. In some centers, LVADs are implanted with a minimally invasive surgical (MIS) approach using a mini-thoracotomy. However, little data exists comparing outcomes of these two techniques. Methods and Materials All Heartware continuous flow LVADS (HVAD) implanted at our institution were included in this analysis. We assessed the baseline characteristics and in-hospital as well as long terms outcomes (using INTERMACS definitions) in those who had CON vs. MIS implantation. Results Between May 2010 and Sept 2012, 40 HVADs were implanted. Of those, 15 (37%) were MIS and 25 (63%) were CON. Median length of support censored at time of transplantation was 149 days for MIS and 181 days for CON. The average age in the MIS group was lower than the CON group (48 vs. 57, p = 0.04), but other baseline characteristics were similar between the MIS and CON groups: male sex 60% vs 76%, ischemic etiology 33% vs 56%, INTERMACS 1 or 2 levels 80% vs 84% (P > 0.05 for all). Cardiopulmonary bypass time was shorter in MIS vs. CON (28.6 vs 70.0 min, p = 0.01). The average number of packed red cell transfusions in-hospital was similar between the two groups. The rates of complications using the INTERMACS definitions in MIS and CON groups were similar for the two groups: 20% vs 12% for renal dysfunction, 27% vs. 48% for respiratory failure, 40% vs 40% for major infection, and 20% vs 36% for neurologic dysfunction, respectively. Thirty-day and over-all mortality were 0% and 13% for MIS and 12% and 12% for CON, respectively (P > 0.05). Conclusions MIS implantation of HVAD is associated with similar risk of complications to CON implantation and there is no difference in short and long-term mortality. More rigorous trials are needed to assess the efficacy and safety of MIS implantation.