Results of Minimally Invasive HVAD Insertion in a Large Cohort of Unselected Patients

Abstract

Purpose Prior reports on minimally invasive LVAD insertion have focused on smaller and/or highly selected populations. Since 2016 we have used the lateral thoracotomy-hemisternotomy (LTHS) technique and the Heartware HVAD as our default approach for all patients. We compare these outcomes to our results with conventional sternotomy (CS). Methods Since April 2016, 58/61 HVAD patients (representing 61/62 total LVAD insertions) underwent LTHS. Two patients had CS due to stem-cell trial restrictions; one had a posterolateral thoracotomy due to hostile sternum . Outcomes of 60 LTHS procedures were compared to 52 CS dating to 2011. Results Preoperative characteristics (Table 1) were similar except for more males in the LTHS group. No patient was excluded from LTHS due to low Intermacs profile, presence of PFO/ASD, or high RV failure risk. Postoperative outcomes are shown in Table 2. Operative time was longer for LTHS. However, cardiopulmonary bypass (CPB) time, RVAD use, intraoperative red blood cell (RBC) transfusion ≥4U, reoperation for bleeding, operative mortality , and hospital length of stay (LOS) were all lower. One-year Kaplan-Meier estimated survival was 90% LTHS vs 65% CS (p=0.003). Conclusion Improved perioperative and long-term outcomes were observed when employing LTHS as the default technique in a large group of unselected patients.