Mid-Term Outcomes after Limited Incision HeartWare Ventricular Assist Device Implantation

Objectives: Limited incision left ventricular assist device (LVAD) implantation has evolved as an alternative to standard median sternotomy. We present our mid-term outcomes with this innovative approach regarding survival and perioperative adverse events.

Methods: From February 2012 to September 2016 limited incision LVAD implantation was performed in 66 patients (mean age 59 ± 9 years; male: 85%; ischemic cardiomyopathy: 58%; Intermacs Level 1: 29%, 2: 15%, 3: 30%, 4–7: 26%; 20% redo surgery) receiving a HeartWare HVAD®. Apical exposure was achieved via a left-sided mini-thoracotomy in all patients. In isolated LVAD procedures, the outflow graft anastomosis was either performed to the ascending via a right anterior thoracotomy (n = 42; 64%) or the left subclavian artery (n = 24; 36%). In case of concomitant valve procedures (aortic and/or tricuspid) or temporary RVAD implantation an upper hemisternotomy was performed (n = 7; 11%). Circulatory support was cardiopulmonary bypass in 30% and ECMO in 32%. Off-pump implantation was performed in 38%.

Results: Less invasive LVAD implantation was feasible in all patients with no need for conversion. Thirty-day and in-hospital mortality were 6% and 15%, respectively. Median follow up time was 520 days, ranging from 4 to 1499 days. Surgical revision for bleeding was necessary in four patients (6%), including one retroperitoneal hematoma and three hemothoraces. One- and two-year survival was 79% and 70%, respectively.

Conclusion: Less invasive LVAD implantation techniques are feasible and safe in a variety of settings and especially appealing in critically ill patients and redo cases. Even selected concomitant cardiac procedures are possible if needed.

No conflict of interest has been declared by the author(s).