Evaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: The LATERAL clinical trial

McGee, Edwin C.; Danter, Matthew; Strueber, M.; Mahr, Claudius; Mokadam, Nahush A.; Wieselthaler, Georg; Klein, Liviu; Lee, Sang-Jin; Boeve, Theodore; Maltais, Simon; Pretorius, Gert; Adler, Eric; Vassiliades, Thomas A.; Cheung, Anson

doi:10.1016/j.healun.2019.02.002

Cited by 154 publications

(194 citation statements)

References 15 publications

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“…Other percutaneous options are available for right‐sided support including but not limited to Protek Duo (TandemLife, Pittsburgh, PA) and Impella RP (Abiomed, Danvers, MA), have been shown to improve right ventricular recovery and also be potential BTT options 12,13 . Recent evidence has suggested that patients undergoing left thoracotomy CF‐LVAD implantation reduces the postimplant adverse events and may improve the potential for successful BTT 14,15 . Few studies have evaluated the impact of simultaneous CF‐LVAD and T‐RVADs in patients bridged to transplant.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Recent evidence has suggested that patients undergoing left thoracotomy CF-LVAD implantation reduces the postimplant adverse events and may improve the potential for successful BTT. 14,15 Few studies have evaluated the impact of simultaneous CF-LVAD and T-RVADs in patients bridged to transplant. Our data suggest that patients with prior CF-LVADs and simultaneous T-RVAD support had comparable early and late survival to isolated CF-LVADs.…”

Section: Discussionmentioning

confidence: 99%

“…The rates of prolonged ventilator support were higher in the durable group (32% vs 4%; P < .0001). The median length of hospital stay following OHT was longer in the T-LVAD group (15 days [IQR,[12][13][14][15][16][17][18][19][20][21][22] vs 19 days [IQR,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]; P = .01). The rates of graft failure and rejection 1-year posttransplant were similar between the groups, as was the functional status at most recent follow-up.…”

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confidence: 99%

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Temporary left ventricular assist devices as a bridge to heart transplantation

et al. 2020

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Background To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T‐LVADs). The outcomes following a direct bridge from a T‐LVAD to orthotopic heart transplant (OHT) are not well delineated. Aim This study investigates the T‐LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T‐LVADs to patients bridged with durable continuous‐flow left ventricular assist devices (CF‐LVADs). Methods Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF‐LVAD and T‐LVADs, with or without temporary right ventricular assist devices (T‐RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes. Results Of 504 patients waitlisted with T‐LVADs, the majority were transplanted (50%), bridged to CF‐LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF‐LVADs and 172 T‐LVADs. Early survival in propensity‐matched T‐LVAD ± T‐RVAD patients was similar to CF‐LVAD ± T‐RVAD patients but reduced at a 1‐year follow‐up. This difference in survival at 1‐year follow‐up was attributable to significantly reduced survival in patients with combined T‐LVAD + T‐RVAD support when compared with CF‐LVAD, isolated T‐LVAD and combined CF‐LVAD + T‐RVAD support (80% vs 90% vs 90% vs 91%; P = .005). Conclusions This study demonstrates that most patients waitlisted with a T‐LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T‐RVADs are not required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Temporary left ventricular assist devices as a bridge to heart transplantation

et al. 2020

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“…Herein we report the case of a HeartMate 3 exchange via bilateral minithoracotomy incisions for treatment of pump and outflow graft thrombosis. Sternal‐sparing approaches for primary LVAD implantation have previously demonstrated early evidence of numerous potential benefits compared with sternotomy, including fewer transfusions, less right ventricular failure, and shorter hospital length of stay 4,5 . Nonsternotomy approaches also afford the benefit of potentially improving the speed and safety of a subsequent orthotopic heart transplantation by reducing the inherent risks of re‐entry sternotomy by decreasing postoperative sternal adhesions.…”

Section: Commentmentioning

confidence: 99%

“…Sternal-sparing approaches for primary LVAD implantation have previously demonstrated early evidence of numerous potential benefits compared with sternotomy, including fewer transfusions, less right ventricular failure, and shorter hospital length of stay. 4,5 Nonsternotomy approaches also afford the benefit of potentially improving the speed and safety of a subsequent orthotopic heart transplantation by reducing the inherent risks of re-entry sternotomy by decreasing postoperative sternal adhesions. To preserve these potential benefits of less invasive primary implantation, adverse events requiring LVAD exchange must also be managed through nonsternotomy approaches.…”

Section: Commentmentioning

confidence: 99%

HeartMate 3 pump exchange via sternal‐sparing bilateral minithoracotomies

et al. 2020

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As median survival for left ventricular assist device (LVAD) patients increases, the incidence of adverse events requiring device exchange is likely to increase as well. Less invasive surgical approaches for device exchange of older generation pumps have demonstrated multiple potential benefits compared with median sternotomy. However, there remains a paucity of data in regard to less invasive surgical techniques for the exchange of the newest generation intrapericardial devices. In this report we describe a complete sternal‐sparing technique for the LVAD exchange of a HeartMate 3 via bilateral minithoracotomies.

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Take‐Home Messages of the Major Clinical Trials in Mechanical Circulatory Support

Skendelas,

Goldstein

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Evaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: The LATERAL clinical trial

Cited by 154 publications

References 15 publications

Temporary left ventricular assist devices as a bridge to heart transplantation

Temporary left ventricular assist devices as a bridge to heart transplantation

HeartMate 3 pump exchange via sternal‐sparing bilateral minithoracotomies

Take‐Home Messages of the Major Clinical Trials in Mechanical Circulatory Support

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