Sternal-Sparing Approach for LVAD Implantation Allows for a More Consistent Inflow Cannula Angle

Ayers, Brian; Marini, Thomas J.; Wood, Katherine; Kim, S.; Croake, Mary Frances; Bernstein, Wendy K.; Storozynsky, Eugene; Tallman, Martin S.; Cheyne, C.; Barrus, Bryan; Prasad, Sunil; Gošev, Igor

doi:10.1016/j.healun.2020.01.261

Cited by 4 publications

(4 citation statements)

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“…[6][7][8][9] Moreover, in our cohort of patients, inflow cannula angles were smaller and more consistent when the BT technique was used. We, therefore, validate the findings of Ayers et al, 13 who also demonstrated smaller and more consistent inflow cannula angles after sternal-sparing implantation in patients who received the HM3 LVAD.…”

Section: Commentsupporting

confidence: 89%

“…Furthermore, angles of 65° or lesser were associated with reduced heart failure readmission rates 11 . Prior work has also suggested that inflow cannula angles after LVAD implantation can be more consistently reproduced with a sternal‐sparing approach, compared to median sternotomy 13 …”

Section: Introductionmentioning

confidence: 99%

“…11 Prior work has also suggested that inflow cannula angles after LVAD implantation can be more consistently reproduced with a sternal-sparing approach, compared to median sternotomy. 13 Increasing adoption of sternal-sparing approaches to LVAD implantation underscores the need for individual institutions to illustrate their experience and patient outcomes using these techniques.…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular assist device implantation by bi‐thoracotomy technique: A single‐center perspective

Stoeckl

Smith

Dhingra

et al. 2021

Journal of Cardiac Surgery

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Background: Left ventricular assist devices (LVAD) are standardly implanted via full sternotomy. Nonsternotomy approaches are gaining popularity, but potential benefits of this approach have not been well-studied. We hypothesized that LVAD implantation by bi-thoracotomy (BT) would demonstrate smaller and more consistent inflow cannula angles leading to improved postoperative outcomes compared to sternotomy.Methods: Charts of patients who underwent LVAD implantation between June 2018 and June 2020 at a single academic institution were retrospectively reviewed.

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Section: Commentsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left ventricular assist device implantation by bi‐thoracotomy technique: A single‐center perspective

Stoeckl

Smith

Dhingra

et al. 2021

Journal of Cardiac Surgery

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“…[5][6][7][8][9] Several physiologic explanations for this observation have been postulated including better pericardial and RV septal geometric preservation, reduced risk of RV free-wall tethering, less perioperative bleeding, and even superior position of the inflow cannula with LIS strategy. 10,11 However, the true impact of these implant strategies on RV function remains unclear, in part because of the technical challenges of imaging the RV postimplant as well as the load dependence of RV function. The gold standard to assess ventricular function relies on pressure-volume relations, which allows for determination of load-independent RV contractility and RV-pulmonary arterial (RV-PA) coupling.…”

mentioning

confidence: 99%

Right Ventricular Contractility and Pulmonary Arterial Coupling After Less Invasive Left Ventricular Assist Device Implantation

Adly,

Mithoefer,

Elliott Epps

et al. 2023

ASAIO Journal

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Right ventricular failure contributes significantly to morbidity and mortality after left ventricular assist device implantation. Recent data suggest a less invasive strategy (LIS) via thoracotomy may be associated with less right ventricular failure than conventional median sternotomy (CMS). However, the impact of these approaches on load-independent right ventricular (RV) contractility and RV-pulmonary arterial (RV-PA) coupling remains uncertain. We hypothesized that the LIS approach would be associated with preserved RV contractility and improved RV-PA coupling compared with CMS. We performed a retrospective study of patients who underwent durable, centrifugal left ventricular assist device implantation and had paired hemodynamic assessments before and after implantation. RV contractility (end-systolic elastance [Ees]), RV afterload (pulmonary effective arterial elastance [Ea]), and RV-PA coupling (Ees/Ea) were determined using digitized RV pressure waveforms. Forty-two CMS and 21 LIS patients were identified. Preimplant measures of Ees, Ea, and Ees/Ea were similar between groups. After implantation, Ees declined significantly in the CMS group (0.60–0.40, p = 0.008) but not in the LIS group (0.67–0.58, p = 0.28). Coupling (Ees/Ea) was unchanged in CMS group (0.54–0.59, p = 0.80) but improved significantly in the LIS group (0.58–0.71, p = 0.008). LIS implantation techniques may better preserve RV contractility and improve RV-PA coupling compared with CMS.

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Right Ventricular Function Following Sternotomy Versus a Less-Invasive Approach for Left Ventricular Assist Device Implant: Retrospective Cohort Study

Sun,

Yen,

Peng

et al. 2024

Journal of Cardiothoracic and Vascular Anesthesia

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Sternal-Sparing Approach for LVAD Implantation Allows for a More Consistent Inflow Cannula Angle

Cited by 4 publications

References 0 publications

Left ventricular assist device implantation by bi‐thoracotomy technique: A single‐center perspective

Left ventricular assist device implantation by bi‐thoracotomy technique: A single‐center perspective

Right Ventricular Contractility and Pulmonary Arterial Coupling After Less Invasive Left Ventricular Assist Device Implantation

Right Ventricular Function Following Sternotomy Versus a Less-Invasive Approach for Left Ventricular Assist Device Implant: Retrospective Cohort Study

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