Improved Early Survival With a Nonsternotomy Approach for Continuous-Flow Left Ventricular Assist Device Replacement

HeartMate 3 pump exchange via sternal‐sparing bilateral minithoracotomies

“…Numerous studies have demonstrated that LVAD exchange is technically possible, 6,7 but not without perioperative risks 8 . The less invasive subcostal approach for HMII exchange has been shown to have numerous benefits compared with re‐entry median sternotomy, including decreased transfusion requirements, shorter hospital length of stay, and improved overall survival 1,2,9 . A less invasive approach for HM3 exchange is considered more technically challenging given the newer device's intrapericardial location and lack of associated pump pocket, reducing the physical space the surgeon is afforded to operate.…”

“…8 The less invasive subcostal approach for HMII exchange has been shown to have numerous benefits compared with re-entry median sternotomy, including decreased transfusion requirements, shorter hospital length of stay, and improved overall survival. 1,2,9 A less invasive approach for HM3 exchange is considered more technically challenging given the newer device's intrapericardial location and lack of associated pump pocket, reducing the physical space the surgeon is afforded to operate. To our knowledge, this is the first report of an HM3 exchange through the sternal-sparing approach, demonstrating that it is technically feasible.…”

“…However, there continue to be patient morbidity and adverse events associated with device support, some of which require reintervention. Compared with median sternotomy, less invasive surgical approaches have shown numerous benefits for the exchange of the HeartMate II (HMII; Abbott, Chicago, IL) 1,2 . However, technical feasibility of a less invasive approach to exchange of the newer, intrapericardial HeartMate 3 (HM3; Abbott) remains largely unknown.…”

“…Compared with median sternotomy, less invasive surgical approaches have shown numerous benefits for the exchange of the HeartMate II (HMII; Abbott, Chicago, IL). 1,2 However, technical feasibility of a less invasive approach to exchange of the newer, intrapericardial HeartMate 3 (HM3; Abbott) remains largely unknown. In this report, we present a case of HM3 pump exchange via the complete sternal-sparing bilateral thoracotomy approach.…”

Operating in the Dark

“…Furthermore, evolving surgical techniques, including a nonsternotomy approach to exchange, may be associated with decreased morbidity and mortality. 16 The study by Levin et al 3 begins to address the large gap that still exists in our understanding of optimal hemolysis management. Although the risks associated with hemolytic events have been described previously, this analysis provides insight into outcomes associated with specific treatment strategies.…”