Subxiphoid Exchange of HeartMate II Left Ventricular Assist Device

Abstract

With increasing use of left ventricular assist devices (LVADs) for long-term circulatory support comes a growing need for device exchange. The conventional surgical approach for device exchanges has been a reoperative median resternotomy. Less-invasive HeartMate II LVAD exchange via a nonmuscle-dividing subxiphoid incision as an alternative to a left subcostal incision may reduce pain burden and facilitate recovery. From November 2006 to June 2015, 292 patients underwent HeartMate II LVAD placement, of which 30 (10.3%) required an exchange. Twenty-four (80%) LVAD exchanges were performed through a subxiphoid sternal-sparing approach and six (20%) through reoperative sternotomy. Predominant indication for device exchange was suspected or confirmed pump thrombus (73.3%), followed by electromechanical pump dysfunction (16.7%). The subxiphoid approach resulted in significantly shorter median intensive care unit (7 vs. 37 days, p = 0.01) and hospital stay (29 vs. 107 days, p = 0.01) compared with reoperative sternotomy. Kaplan-Meier analysis showed comparable survival between the subgroups (p = 0.15) as well as between the patients with device exchange and the rest of the HeartMate II LVAD patients at our institution (p = 0.12). Subxiphoid device exchange is a viable option, resulting in low operative morbidity and mortality with no adverse effect on late survival.