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Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience.

BACKGROUND:  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).

METHODS:  HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n  = 22, 52 ± 15 years old; STX group n  = 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.

RESULTS:  No survival differences were observed between the LT and STX group ( p  = 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 ( p  = 0.02), which could not be demonstrated in the STX group ( p  = 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 ( n  = 4 LT group vs n  = 20 STX group, p  = 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 ( p  = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups ( p  = 0.48).

CONCLUSION:  The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.

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