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.