Implantation of a fully magnetically levitated left ventricular assist device using a sternal-sparing surgical technique

Igor Gosev, Katherine Wood, Brian Ayers, Bryan Barrus, Peter Knight, Jeffrey D. Alexis, Himabindu Vidula, Heather Lander, Julie Wyrobek, Christina Cheyne, Ilan Goldenberg, Scott McNitt, Sunil Prasad

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Left ventricular assist devices (LVADs) have improved outcomes for selected patients with advanced heart failure, but alternative optimal surgical techniques remain to be defined. We aim to describe our initial experience in using a sternal-sparing (SS) technique for implantation of a magnetically levitated LVAD, the HeartMate 3 (HM3) pump. Methods: This retrospective, single-center study included consecutive patients implanted with the HM3 LVAD between September 2015 and September 2018. Patients were compared based on surgical approach: SS or traditional sternotomy (TS). The primary outcome was overall survival at 6 months. Secondary outcomes included peri-operative complications, blood product utilization, and hospital readmissions. Results: Of 105 patients implanted with the HM3 LVAD, 41 (39%) were implanted via SS and 64 (61%) via TS approach. There were no intraoperative conversions. The SS patients were younger; otherwise, all other characteristics were similar between cohorts. The SS cohort demonstrated a significantly lower incidence of severe right ventricular failure (7% vs 28%, p = 0.012), fewer blood-product transfusions (41% vs 86%, p < 0.001), and shorter index hospital length of stay (15.5 vs 21 days, p = 0.018). Six-month survival was 93% for the SS cohort. Conclusions: In this single-center observational study, we have demonstrated that the SS approach may be a safe and effective surgical technique for implantation of the HM3 LVAD in well-selected patients. The potential benefits compared with TS require further inquiry.

Original languageEnglish
Pages (from-to)37-44
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number1
DOIs
StatePublished - Jan 2020
Externally publishedYes

Keywords

  • LIS
  • left ventricular assist device
  • less invasive surgery
  • mechanical circulatory support
  • minimally invasive techniques
  • sternal sparing
  • surgical techniques

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