Left Thoracotomy Upper Hemisternotomy Left Ventricular Assist Device (LVAD) Implantation Offers Safe, Durable Option for Patients with Prior Sternotomy Undergoing LVAD Implantation

Foley, Neal; Zalawadiya, Sandip; Kuzemchak, Marie D.; Balsara, Keki R.; Menachem, Jonathan N.; Schlendorf, Kelly; Maltais, Simon; Shah, Ashish S.; Danter, Matthew

doi:10.1016/j.healun.2019.01.934

Cited by 2 publications

(3 citation statements)

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“…However, the bi-thoracotomy approach has also been popularized in many centers. There are pros and cons associated with each technique [ 40 , 41 , 42 ].…”

Section: Patient Management and Optimizationmentioning

confidence: 99%

“…The less invasive approach includes a bi-thoracotomy incision in the left lateral chest wall over the left ventricular apex area to place the inflow cannula and in the right second intercostal space to place the outflow graft [ 40 , 41 , 42 ]. The role of this less invasive approach is primarily in BTT patients, and the main advantage is preservation of the sternum for the subsequent heart transplantation.…”

Section: Patient Management and Optimizationmentioning

confidence: 99%

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The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

Berardi

Bravo

et al. 2022

JCM

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The utilization of left ventricular assist devices (LVADs) in end-stage heart failure has doubled in the past ten years and is bound to continue to increase. Since the first of these devices was approved in 1994, the technology has changed tremendously, and so has the medical and surgical management of these patients. In this review, we discuss the history of LVADs, evaluating survival and complications over time. We also aim to discuss practical aspects of the medical and surgical management of LVAD patients and future directions for outcome improvement in this population.

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“…However, the bi-thoracotomy approach has also been popularized in many centers. There are pros and cons associated with each technique [ 40 , 41 , 42 ].…”

Section: Patient Management and Optimizationmentioning

confidence: 99%

Section: Patient Management and Optimizationmentioning

confidence: 99%

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

Berardi

Bravo

et al. 2022

JCM

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“…The landmark LATERAL trial confirmed the safety and efficacy of LVAD implantation via thoracotomy 7 and 2year follow up demonstrated reduced overall non-surgical bleeding events in those who were implanted via thoracotomy compared to conventional sternotomy, as well as 95% freedom from disabling stroke. 8 Implantation via thoracotomy may mitigate some of the technical challenges of implantation as it allows for improved visualization and flexibility, 9 allowing more optimal inflow cannula placement. We assessed the impact of surgical approach on optimal cannula placement by comparing outcomes between lateral thoracotomy and conventional sternotomy approaches for LVAD implantation.…”

Section: Introductionmentioning

confidence: 99%

Comparing left ventricular assist device inflow cannula angle between median sternotomy and thoracotomy using 3D reconstructions

et al. 2023

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Background Left ventricular assist device (LVAD) implantation via thoracotomy has many potential advantages compared to conventional sternotomy, including improved inflow cannula (IFC) positioning. We compared the difference in IFC angles, postoperative, and long‐term outcomes for patients with LVADs implanted via thoracotomy and sternotomy. Methods A single‐center, retrospective analysis of 14 patients who underwent thoracotomy implantation was performed and matched with 28 patients who underwent sternotomy LVAD implantations for a total of 42 patients. Inclusion required a minimum LVAD support duration of 30 days and excluded concomitant procedures. A postoperative CT‐chest was used to measure the angle the between the IFC and mitral valve in two‐dimensions and results were compared with three‐dimensional reconstruction using the same CT chest. Outcome data were extracted from medical records. Results There was no significant difference in gender, INTERMACS score, BMI, or age between the two groups. Median cardiopulmonary bypass time was longer in the thoracotomy group compared to the sternotomy group, 107 min (86–122) versus 76 min (56–93), p < 0.01. 3D reconstructions revealed less deviation of the IFC away from the mitral valve in devices implanted via thoracotomy compared to sternotomy, median (IQR) angle 16.3° (13.9°–21.0°) versus 23.2° (17.9°–26.4°), p < 0.01. Rates of pump thrombosis, stroke, and gastrointestinal bleeding were not significantly different. Conclusions Devices implanted via thoracotomy demonstrated less deviation away from mitral valve. However, there was no difference in morbidity between the two approaches. 3D reconstruction of the heart is an innovative technique to measure angulation and is clinically advantageous when compared to 2D imaging.

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Left Thoracotomy Upper Hemisternotomy Left Ventricular Assist Device (LVAD) Implantation Offers Safe, Durable Option for Patients with Prior Sternotomy Undergoing LVAD Implantation

Cited by 2 publications

References 0 publications

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

Comparing left ventricular assist device inflow cannula angle between median sternotomy and thoracotomy using 3D reconstructions

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