Reichart D, Brand C F, Bernhardt A M, Schmidt S, Schaefer A, Blankenberg S, Reichenspurner H, Wagner F M, Deuse T, Barten M J
Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany.
Thorac Cardiovasc Surg. 2019 Apr;67(3):170-175. doi: 10.1055/s-0038-1649493. Epub 2018 May 27.
Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group).
HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group = 22, 52 ± 15 years old; STX group = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed.
No survival differences were observed between the LT and STX group ( = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation ( = 0.02), which could not be demonstrated in the STX group ( = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections ( = 4 LT group vs = 20 STX group, = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group ( = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups ( = 0.48).
The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.
微创左心室辅助装置（LVAD）植入术可能会减少与再次开胸相关的围手术期/术后并发症及风险。在本研究中，我们描述了使用微创LVAD植入技术（侧胸壁切开术[LT]组）的首批结果。这些结果与通过完全正中胸骨切开术进行的LVAD植入术（STX组）进行了比较。
对70例患者的HVAD（美国马萨诸塞州弗雷明汉市HeartWare公司）植入术（LT组=22例，年龄52±15岁；STX组=48例，年龄59±11岁）进行回顾性分析。22例患者通过左胸壁切开术进行微创入路是可行的。对生存情况和不良事件进行了围手术期及术后分析。
LT组和STX组之间未观察到生存差异（P=0.43）。与同时植入临时右心室辅助装置（tRVAD）的LT患者相比，未植入tRVAD的LT患者生存率显著更高（P=0.02），而在STX组中未观察到这种情况（P=0.11）。2例LT患者和4例STX患者成功过渡到心脏移植，3例STX患者成功撤机并随后取出LVAD。LT组LVAD相关感染（LT组=4例 vs STX组=20例，P=0.04）的发生率较低。LT组未发生伤口裂开，而STX组观察到5例（P=0.17）。两个研究组围手术期输血量（术后第1个7天内）无差异（P=0.48）。
微创方法是一种可行的替代方案，有可能减少并发症，对于过渡到移植的患者应特别予以考虑。
