Faculty of Medicine, Department of Thoracic and Cardiovascular Surgery (U.A., M.A.K., A.M., L.T., R.A., H.S., R.Z.), RWTH University Hospital Aachen, RWTH Aachen University, Germany.
Faculty of Medicine, Department of Anesthesiology (G.S., A.G.), RWTH University Hospital Aachen, RWTH Aachen University, Germany.
Circ Heart Fail. 2022 May;15(5):e008358. doi: 10.1161/CIRCHEARTFAILURE.121.008358. Epub 2022 Mar 7.
Minimally invasive surgery for left ventricular assist device implantation may have advantages over conventional sternotomy (CS). Additionally, ultra-fast-track anesthesia has been linked to better outcomes after cardiac surgery. This study summarizes our early experience of combining minimally invasive surgery with ultra-fast-track anesthesia (MIFTA) in patients receiving HeartMate 3 devices and compares the outcomes between MIFTA and CS.
From October 2015 to January 2019, 18 of 49 patients with Interagency Registry for Mechanically Assisted Circulatory Support profiles >1 underwent MIFTA for HeartMate 3 implantation. For bias reduction, propensity scores were calculated and used as a covariate in a regression model to analyze outcomes. Weighted parametric survival analysis was performed.
In the MIFTA group, intensive care unit stays were shorter (mean difference, 8 days [95% CI, 4-13]; <0.001), and the incidences of pneumonia and right heart failure were lower than those in the CS group (odds ratio, 1.36 [95% CI, 1.01-1.75]; =0.016, respectively). At 6 and 12 hours postoperatively, MIFTA patients had a better hemodynamic performance with lower pulmonary wedge pressure (mean difference, 2.23 mm Hg [95% CI, 0.41-4.06]; =0.028) and a higher right ventricular stroke work index (mean difference, -1.49 g·m/m per beat [95% CI, -2.95 to -0.02]; =0.031). CS patients had a worse right heart failure-free survival rate (hazard ratio, 2.35 [95% CI, 0.96-5.72]; <0.01).
Compared with CS, MIFTA is a beneficial approach for non-Interagency Registry for Mechanically Assisted Circulatory Support 1 HeartMate 3 patients with lower adverse event incidences, better hemodynamic performance, and preserved right heart function. Future large multicentric investigations are required to verify MIFTA's effects on outcomes.
与传统的胸骨切开术（CS）相比，微创左心室辅助装置植入术可能具有优势。此外，心脏手术后的超快速通道麻醉与更好的结果相关。本研究总结了我们在接受 HeartMate 3 装置的患者中结合微创和超快速通道麻醉（MIFTA）的早期经验，并比较了 MIFTA 与 CS 的结果。
从 2015 年 10 月至 2019 年 1 月，49 名 Interagency Registry for Mechanically Assisted Circulatory Support 分级 >1 的患者中，有 18 名接受了 MIFTA 进行 HeartMate 3 植入。为了减少偏差，计算了倾向评分，并将其用作回归模型中的协变量来分析结果。进行了加权参数生存分析。
在 MIFTA 组中，重症监护病房的住院时间更短（平均差异 8 天[95%置信区间，4-13]；<0.001），肺炎和右心衰竭的发生率低于 CS 组（比值比，1.36[95%置信区间，1.01-1.75]；=0.016）。在术后 6 小时和 12 小时，MIFTA 患者的血流动力学表现更好，肺动脉楔压更低（平均差异 2.23 毫米汞柱[95%置信区间，0.41-4.06]；=0.028），右心室每搏做功指数更高（平均差异-1.49 克·米/米/次[95%置信区间，-2.95 至-0.02]；=0.031）。CS 患者的右心衰竭无事件生存率更差（风险比，2.35[95%置信区间，0.96-5.72]；<0.01）。
与 CS 相比，MIFTA 是一种有益的方法，可用于非 Interagency Registry for Mechanically Assisted Circulatory Support 1 HeartMate 3 患者，其不良事件发生率更低，血流动力学表现更好，右心功能保存更好。需要进一步进行大型多中心研究来验证 MIFTA 对结果的影响。
