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Pearman M, Emmanuel S, Jansz P, Watson A, Connellan M, Iyer A, Barua S, Hayward CS. Comparing left ventricular assist device inflow cannula angle between median sternotomy and thoracotomy using 3D reconstructions. Artif Organs 2022. [PMID: 36582131 DOI: 10.1111/aor.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
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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Affiliation(s)
- Madeleine Pearman
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia
| | - Sam Emmanuel
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Paul Jansz
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Alasdair Watson
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia
| | - Mark Connellan
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia
| | - Arjun Iyer
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia
| | - Sumita Barua
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Christopher Simon Hayward
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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Loforte A, Gliozzi G, Mariani C, Cavalli GG, Martin-Suarez S, Pacini D. Ventricular assist devices implantation: surgical assessment and technical strategies. Cardiovasc Diagn Ther 2021; 11:277-291. [PMID: 33708499 PMCID: PMC7944211 DOI: 10.21037/cdt-20-325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
Along with the worldwide increase in continuous left ventricular assist device (LVAD) strategy adoption, more and more patients with demanding anatomical and clinical features are currently referred to heart failure (HF) departments for treatment. Thus surgeons have to deal, technically, with re-entry due to previous cardiac surgery procedures, porcelain aorta, peripheral vascular arterial disease, concomitant valvular or septal disease, biventricular failure. New surgical techniques and surgical tools have been developed to offer acceptable postoperative outcomes to all mechanical circulatory support recipients. Several less invasive and/or thoracotomic approaches for surgery combined with various LVAD inflow and outflow graft alternative anastomotic sites for system placement have been reported and described to solve complex clinical scenarios. Surgical techniques have been upgraded with further technical tips to preserve the native anatomy in case of re-entry for heart transplantation, myocardial recovery or device explant. The current continuous-flow miniaturized and intrapericardial devices provide versatility and technical advantages. However, the surgical planning requires a careful multidisciplinary evaluation which must be driven by a dedicated and well-trained Heart Failure team. Biventricular assist device (BVAD) implantation by adoption of the newer radial pumps might be a challenge. However, the results are encouraging thus remaining a valid option. This paper reviews and summarizes LVAD preoperative assessment and current surgical techniques for implantation.
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Affiliation(s)
- Antonio Loforte
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Carlo Mariani
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Sofia Martin-Suarez
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Davide Pacini
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
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Sandoval E, Fernández-Cisneros A, Pereda D. Minimally invasive single-incision temporary biventricular assist device. Asian Cardiovasc Thorac Ann 2020; 28:604-606. [PMID: 33141596 DOI: 10.1177/0218492320951014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
New short-term devices have been developed to allow percutaneous insertion. However, in some cases, open insertion becomes necessary. Less invasive insertion of short-term devices has been described previously, using two incisions. We present the case of a patient who underwent minimally invasive insertion of a biventricular device, using a single incision.
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Affiliation(s)
- Elena Sandoval
- Cardiovascular Surgery Department, ICCV, Hospital Clínic, Barcelona, Spain
| | | | - Daniel Pereda
- Cardiovascular Surgery Department, ICCV, Hospital Clínic, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares, Madrid, Spain
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4
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König T, Hanke JS, Dogan G, Kempf T, Sieweke JT, Schäfer A, Bauersachs J, Schmitto JD, Napp LC. Advanced Preconditioning: Impella 5.5 Support for Decompensated Heart Failure Before Left Ventricular Assist Device Surgery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:189-192. [PMID: 32950404 DOI: 10.1016/j.carrev.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, and available devices and surgical techniques have strongly evolved over time. Adequate recompensation of patients before surgery is important for optimal surgical outcomes. However, patients with terminal heart failure frequently suffer from cardiorenal syndrome, which complicates recompensation by medical means. Here, we report on the use of an Impella 5.5 microaxial pump for supporting a patient with severely decompensated heart failure before LVAD implantation, which resulted in hemodynamic stabilization and effective recompensation prior to surgery.
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Affiliation(s)
- Tobias König
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan-Thorben Sieweke
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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Chatterjee A, Mariani S, Hanke JS, Li T, Merzah AS, Wendl R, Haverich A, Schmitto JD, Dogan G. Minimally invasive left ventricular assist device implantation: optimizing device design for this approach. Expert Rev Med Devices 2020; 17:323-330. [PMID: 32118488 DOI: 10.1080/17434440.2020.1735358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The global heart failure (HF) burden is expected to increase due to aging populations, increasing number of end-stage HF patients and adverse lifestyle changes. Mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs) have become a promising treatment option for short-term and long-term circulatory support of end-stage HF patients.Areas covered: Recent developments in MCS technology have been focused on miniaturization leading to the development of minimally invasive surgical procedures for LVAD implantation. This helps overcome possible postoperative complications such as major incisions and poor outcomes due to infections, right heart failure, and bleeding. This article discusses clinical and technological developments in the field of minimally invasive procedures for LVAD implantation.Expert opinion: Most patients might benefit from minimally invasive LVAD implantation performed through a limited left lateral thoracotomy associated with an upper hemisternotomy or a right anterior thoracotomy. The thoracotomy approach can also be considered in case of pump exchange or pump explant. The success of these techniques is mainly based on the optimization of LVAD pump design, inflow cannula insertion, and outflow graft as well as driveline exit sites. The future direction of the LVAD field is likely to include less-invasive approaches and smartificial technologies.
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Affiliation(s)
- Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Regina Wendl
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Mariani S, Hanke JS, Li T, Merzah AS, Chatterjee A, Deniz E, Haverich A, Schmitto JD, Dogan G. Device profile of the heartware HVAD system as a bridge-to-transplantation in patients with advanced heart failure: overview of its safety and efficacy. Expert Rev Med Devices 2019; 16:1003-1015. [DOI: 10.1080/17434440.2019.1696674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin Sarah Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ezin Deniz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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