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Worku B, Vinogradsky A, Ibrahim A, Rossi CS, Mack C, Gambardella I, Srivastava A, Takeda K, Naka Y. Outcomes After Heartmate 3 Left Ventricular Assist Device Implantation Using a 10 mm Outflow Graft. ASAIO J 2024:00002480-990000000-00503. [PMID: 38875452 DOI: 10.1097/mat.0000000000002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
The presence of adhesions and patent bypass grafts may create challenges for standard 14 mm outflow graft placement during left ventricular assist device implantation. We retrospectively describe our experience using a 10 mm Bioline Fusion graft (Getinge, Goteborg, Sweden) as the outflow graft in patients undergoing primary Heartmate 3 (Abbott, Abbott Park, IL) implantation. One hundred one patients underwent Heartmate 3 left ventricular assist device implantation, 80% via a thoracotomy approach, with the standard 14 mm outflow graft (78) or a 10 mm Bioline Fusion outflow graft (23). Initial postoperative rotor speed-to-flow ratio (the revolutions per minutes (RPMs) required to achieve a given flow) was significantly higher in 10 mm graft patients (1,472 vs. 1,283 RPM/L/min; p = 0.03), suggesting elevated resistance in the smaller graft. Furthermore, the initial postoperative vasoactive-inotrope score was higher in the 10 mm graft patients (24.1 vs. 17.6; p = 0.022). Postoperative outcomes were similar between groups. In conclusion, the use of a 10 mm graft was associated with higher RPMs needed to generate a given flow and a higher vasoactive-inotrope score, but these differences were not associated with increased right ventricular failure or mortality.
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Affiliation(s)
- Berhane Worku
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital
| | - Alice Vinogradsky
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center
| | - Aminat Ibrahim
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital
| | - Camilla Sofia Rossi
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
| | - Charles Mack
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
- Department of Cardiothoracic Surgery, New York Presbyterian Queens Hospital
| | - Ivancarmine Gambardella
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center
| | - Ankur Srivastava
- Department of Anesthesia Surgery, New York Presbyterian Weill Cornell Medical Center
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center
| | - Yoshifumi Naka
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
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Dimagli A, Worku B, Gaudino M. Commentary: Minimally invasive left ventricular assist device implantation: Did we forget the valve? J Thorac Cardiovasc Surg 2024; 167:744-745. [PMID: 35701243 DOI: 10.1016/j.jtcvs.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | - Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Jimenez Contreras F, Rames JD, Schroder J, Russell SD, Katz J, Omer T, Barac YD, Milano C. Long-term predictors of morbidity and mortality in patients following LVAD replacement. Artif Organs 2024; 48:157-165. [PMID: 37814840 DOI: 10.1111/aor.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND As heart transplant guidelines evolve, the clinical indication for 73% of durable left ventricular assist device (LVAD) implants is now destination therapy. Although completely magnetically levitated LVAD devices have demonstrated improved durability relative to previous models, LVAD replacement procedures are still required for a variety of indications. Thus, the population of patients with a replaced LVAD is growing. There is a paucity of data regarding the outcomes and risk factors for those patients receiving first-time LVAD replacements. METHODS The study cohort consisted of all consecutive patients between 2006 and 2020 that received a first-time LVAD replacement at a single institution. Preoperative clinical and laboratory variables were collected retrospectively. The primary endpoint was death or need for an additional LVAD replacement. Data were subjected to Kaplan-Meier, univariate, and multivariate Cox hazard ratio analyses. RESULTS In total, 152 patients were included in the study, of which 101 experienced the primary endpoint. On multivariate analysis, patients receiving HeartMate 3 (HM3) LVADs as the replacement device showed superior outcomes (HR 0.15, 95% CI 0.065-0.35, p < 0.0001). Independent risk factors for death or need for additional replacement included preoperative extracorporeal membrane oxygenation (ECMO) (HR 4.44, 95% CI 1.87-14.45, and p = 0.00042), increased number of sternotomies (HR 5.20, 95% CI 1.87-14.45, and p = 0.0016), and preoperative mechanical ventilation (HR 1.98, 95% CI 1.01-3.86, and p = 0.045). CONCLUSIONS Replacement with HM3 showed superior outcomes compared to all other pump types when controlling for both initial pump type and other independent predictors of death or LVAD replacement. Preoperative ECMO, mechanical ventilation, and multiple sternotomies also increased the odds for death or the need for subsequent replacement.
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Affiliation(s)
- Fabian Jimenez Contreras
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Jess David Rames
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jason Katz
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Tariq Omer
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Yaron D Barac
- Division of Cardiovascular and Thoracic Surgery, Rabin Medical Center, Petach-Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmelo Milano
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Akay MH, De Armas IAS, Kar B, Gregoric ID. Is Sternal Sparing Left Ventricular Assist Device Implantation "Minimally" Invasive? ASAIO J 2023; 69:e441-e442. [PMID: 37527626 DOI: 10.1097/mat.0000000000001987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- Mehmet H Akay
- From the Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
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Gregoric ID, Patel M, Akay MH, Salas De Armas I, Patel J, Jezovnik MK, Radovancevic R, Kar B. Off-pump Left Ventricular Assist Device Implantation Through Median Sternotomy Versus Sternal Sparing Approach. ASAIO J 2023; 69:e265-e266. [PMID: 36521006 DOI: 10.1097/mat.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Igor D Gregoric
- From the Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
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Zubair MH, Brovman EY. Lateral thoracotomy versus sternotomy for left ventricular assist device implantation. Curr Opin Anaesthesiol 2023; 36:25-29. [PMID: 36380572 DOI: 10.1097/aco.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Traditionally, left ventricular assist devices (LVADs) are implanted via the standard median sternotomy approach. However, a left thoracotomy approach has been purported to offer physiologic benefits. As a result, utilization of the left thoracotomy for LVAD placement is increasing globally, but the benefits of this approach versus sternotomy are still evolving and debatable. This review compares the median sternotomy and thoracotomy approaches for LVAD placement. RECENT FINDINGS Recent meta-analyses of LVAD implantation via thoracotomy approach suggest that the thoracotomy approach was associated with a reduced incidence of RVF, bleeding, hospital length of stay (LOS), and mortality [1 ▪▪ ,2 ▪▪ ] . No difference in stroke rates was noted. These results offer support as to the feasibility of a thoracotomy approach for LVAD implantation but also highlight its potential superiority over sternotomy. SUMMARY The most recent literature supports the use of lateral thoracotomy for placement of left ventricle assist devices compared to median sternotomy. Long-term outcomes from lateral thoracotomy are still unknown, however, short-term results favor lateral thoracotomy approaches for LVAD implantation. While the conventional median sternotomy approach was the original operative technique of choice for LVAD implantation, lateral thoracotomy is quickly emerging as a potentially superior technique.
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Affiliation(s)
- M Haseeb Zubair
- Department of Anesthesiology, Tufts Medical Center, 800 Washington St., Boston, Massachusetts, USA
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Worku B, Gulkarov I, Gambardella I. Ministernotomy aortic valve replacement: The cost of preference. J Card Surg 2022; 37:4587-4588. [PMID: 36378916 DOI: 10.1111/jocs.17152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, New York, Brooklyn, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Queens Hospital, New York, Queens, USA
| | - Ivan Gambardella
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, New York, Brooklyn, USA
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Worku B, Naka Y. Right ventricular failure after thoracotomy left ventricular assist device; the role of pericardial restraint. J Card Surg 2022; 37:3082-3083. [PMID: 35842795 DOI: 10.1111/jocs.16767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA.,Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Yoshifumi Naka
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA
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Samara E, El-Tahan MR. On the run to minimally-invasive left ventricular assist device off-pump implantation. Anesthesiologists’ Reflections. J Cardiothorac Vasc Anesth 2022; 36:1632-1635. [DOI: 10.1053/j.jvca.2022.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/11/2022]
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Sugimura Y, Sipahi NF, Immohr MB, Yilmaz E, Aissa J, Boeken U, Aubin H, Lichtenberg A, Akhyari P, Dalyanoglu H. Effect of preoperative erector spinae muscles mass on postoperative outcomes in patients with left ventricular assist devices. J Card Surg 2021; 37:297-304. [PMID: 34672025 DOI: 10.1111/jocs.16100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/03/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty influences the postoperative outcomes in patients undergoing left ventricular assist device (LVAD) implantation. Recently, erector spinae muscle (ESM) mass has been proposed as a parameter to assess frailty accurately. Thus, the purpose of the present study was to evaluate whether preoperative ESM mass is associated with short- and long-term clinical outcomes in patients with LVAD. METHODS A total of 119 consecutive patients with LVAD were enrolled between January 2010 and October 2017 at a single heart center. The ESM area, ESM index, and Hounsfield units (HU) of the ESM were calculated by computed tomography for preoperative ESM mass evaluation. We then statistically evaluated the in-hospital mortality, major adverse cardiovascular events (MACE), duration of hospital stay, and long-term survival. RESULTS In a multivariate Cox regression analysis, ESM mass indicated no effect on all clinical outcomes. In addition, the ESM area presented a weak but significant negative linear correlation only with the duration of hospital stay (r = -0.21, p < .05). In contrast, the Model For End-stage Liver Disease (MELD) score and preoperative venous-arterial extracorporeal membrane oxygenation (va-ECMO) were significant predictive factors for in-hospital mortality (MELD score: p < .001, hazard ratio [HR] 1.1; preoperative va-ECMO: p < .01, HR 2.72) and MACE (MELD score: p < .001, HR 1.07; preoperative va-ECMO: p < .005, HR 2.62). CONCLUSION Preoperative ESM mass might predict the length of hospital stay in patients undergoing LVAD implantation. In contrast, it had no effect on MACE, in-hospital mortality, or long-term survival in this study.
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Affiliation(s)
- Yukiharu Sugimura
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Nihat F Sipahi
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Moritz B Immohr
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Esma Yilmaz
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Joel Aissa
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
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