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

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

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.

Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.

Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.

Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

Original languageEnglish (US)
Pages (from-to)107-112
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Heart-Assist Devices
Thoracotomy
Length of Stay
Propensity Score
Sternotomy
Hospital Mortality
Artificial Respiration
Intensive Care Units
Multivariate Analysis

Keywords

  • heart failure
  • left thoracotomy
  • left ventricular assist device
  • off-pump surgery
  • peri-operative outcomes
  • surgical approach

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

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 A.; Davis, Mary E.; Tricarico, Nicole M.; Stulak, John M.; Khalpey, Zain; Danter, Matthew R.; Deegan, Robert; Kennedy, Jason; Keebler, Mary E.; Maltais, Simon.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 1, 01.01.2016, p. 107-112.

Research output: Contribution to journalArticle

Sileshi, B, Haglund, NA, Davis, ME, Tricarico, NM, Stulak, JM, Khalpey, Z, Danter, MR, Deegan, R, Kennedy, J, Keebler, ME & Maltais, S 2016, 'In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device', Journal of Heart and Lung Transplantation, vol. 34, no. 1, pp. 107-112. https://doi.org/10.1016/j.healun.2014.09.023
Sileshi, Bantayehu ; Haglund, Nicholas A. ; Davis, Mary E. ; Tricarico, Nicole M. ; Stulak, John M. ; Khalpey, Zain ; Danter, Matthew R. ; Deegan, Robert ; Kennedy, Jason ; Keebler, Mary E. ; Maltais, Simon. / In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device. In: Journal of Heart and Lung Transplantation. 2016 ; Vol. 34, No. 1. pp. 107-112.
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abstract = "Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8{\%}. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.",
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AU - Haglund, Nicholas A.

AU - Davis, Mary E.

AU - Tricarico, Nicole M.

AU - Stulak, John M.

AU - Khalpey, Zain

AU - Danter, Matthew R.

AU - Deegan, Robert

AU - Kennedy, Jason

AU - Keebler, Mary E.

AU - Maltais, Simon

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N2 - Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

AB - Background Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.Methods Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.Results Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.Conclusions An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

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KW - peri-operative outcomes

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