In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device

Sileshi, Bantayehu; Haglund, Nicholas; Davis, Mary E.; Tricarico, Nicole M.; Stulak, John M.; Khalpey, Zain; Danter, Matthew; Deegan, Robert; Kennedy, Jason D.; Keebler, Mary; Maltais, Simon

doi:10.1016/j.healun.2014.09.023

Cited by 61 publications

(50 citation statements)

References 29 publications

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“…Our technique for outflow graft placement to DA has already been described. 6 In cases where the DA is used for outflow graft anastomosis, a surface echocardiogram is first used to identify the LV apex and a 6 cm LT is accurately made. Femoral access is used for CPB.…”

Section: Alternative Outflow Graft To Descending Aorta or Left Subclamentioning

confidence: 99%

“…The use of an off-pump approach is yet another potential improvement in the technique in selected patients, designed to avoid the associated morbidity of CPB. 6,22 Furthermore, maintaining the pressurevolume relationship of the right ventricle using nonsternotomy, less invasive approach may help decrease the incidence of postoperative rV dysfunction, thereby decreasing morbidity and duration of postoperative inotrope dependence. 6,23 Partial Support Option Using Minimally Invasive, Alternative Outflow?…”

Section: A New Implant Strategy For Bridged Patientsmentioning

confidence: 99%

“…3 The HeartWare ventricular assist device (HVAD; HeartWare International, Inc., Framingham, MA) is an established continuousflow centrifugal pump device that is increasingly implanted using alternative and minimally invasive approaches, often with a sternal-sparing operation. [4][5][6][7][8] With the use of alternative approaches to HVAD implantation, patients who have undergone previous cardiac surgery are potentially able to avoid reoperative sternotomy and associated complications. 9 Previous work has used the minimally invasive left thoracotomy (LT) approach safely and effectively with creation of an ascending aortic, descending aortic, or subclavian artery outflow graft anastomosis.…”

mentioning

confidence: 99%

“…9 Previous work has used the minimally invasive left thoracotomy (LT) approach safely and effectively with creation of an ascending aortic, descending aortic, or subclavian artery outflow graft anastomosis. 4,6,7 Using the thoracotomy approach, one has versatility in anatomic position of outflow graft placement. This may be particularly helpful in the increasingly common reoperative situation that heart failure surgeons face.…”

mentioning

confidence: 99%

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Can an Alternative Outflow Strategy be Utilized for High-Risk Bridged Patients with Previous Cardiac Surgery?

Danish

Davis

et al. 2016

ASAIO Journal

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The HeartWare ventricular assist device (HVAD) is an implantable continuous-flow centrifugal pump that has allowed the development of sternal-sparing techniques, with the use of alternative outflow strategies. We compared early outcomes for patients bridged with the conventional versus alternative outflow graft strategy. From January 2013 to October 2014, 89 patients with HVAD implantation were identified. Survival was analyzed with Kaplan-Meier methods, and a log-rank test was used to compare outcomes between groups. Thirty patients (34%) had ≥1 previous sternotomy before HVAD implantation. Eight patients (27%) were approached using an alternative outflow graft technique with outflow graft connection to the descending aorta (n = 4, 50%) or left subclavian artery (n = 4, 50%), whereas 22 (73%) were implanted via a conventional sternotomy approach with the outflow graft to the ascending aorta. Preoperative characteristics (age, Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS], and Lietz-Miller score) were comparable between groups (all p > 0.05). Median follow-up was 4.7 (2.8-9.3) months of support. Outcomes were comparable between conventional and alternative outflow groups; survival at 6 months was 74% for the conventional group and 83% in the alternative outflow group. An alternative outflow graft strategy can be utilized to support bridged patients with a history of prior sternotomy.

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Section: Alternative Outflow Graft To Descending Aorta or Left Subclamentioning

confidence: 99%

Section: A New Implant Strategy For Bridged Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Can an Alternative Outflow Strategy be Utilized for High-Risk Bridged Patients with Previous Cardiac Surgery?

Danish

Davis

et al. 2016

ASAIO Journal

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“…The MVAD Ò pump (currently for investigational use only; HeartWare Ò , Inc.) is a mechanical assist device with continuous, axial blood flow (5,8). The miniaturized design allows implantation in smaller patients, as well as allowing a potentially shorter hospital stay through use of less invasive surgery such as a thoracotomy (9,10). The design of the pump includes a wear-free impeller suspended in a motor core though passive magnetic and hydrodynamic forces rotating at 8,000-18,000 rpm.…”

mentioning

confidence: 99%

In Vitro PET Imaging of a Miniature Ventricular Assist Device

Gossman¹,

Graham

Depot

et al. 2016

J. Nucl. Med. Technol.

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Interactions between the life-sustaining ventricular assist devices and diagnostic therapies must be carefully considered to decrease the risk of inaccurate diagnostic imaging or pump failure. Methods: The MVAD ® pump, currently under investigational use, was tested for interaction with radiotracers in an in vitro flow-loop study. The radiotracers 18 F-sodium fluoride and 18 F-FDG were injected into a closed loop to determine the feasibility of direct imaging of the MVAD ® pump in a PET scanner. Results: No real-time changes were observed in pump operation, and there were no statistical differences in pump parameters (power consumption, speed, and estimated flow rate) between the baseline and circulation conditions. In addition, no effect was observed on any external components, including the permissive-action-link controller and the batteries powering the device. Imaging of the internal pump components was possible, with obscuration observed only in the portion of the pump where the spinning impeller is located. Retention of radiotracer in the pump components after circulation was minimal (,1%). Conclusion: PET imaging is an attractive diagnostic tool for patients with a ventricular assist device and may have additional utility outside its current use, detection of infection.

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