A subcostal approach is favorable compared to sternotomy for left ventricular assist device exchange field of research: artificial heart (clinical).

Abstract

This is a single-center retrospective study to summarize clinical outcomes of patients requiring surgical continuous-flow left ventricular assist device (HeartMate II) exchange. The patients who underwent HeartMate II exchange were divided into two groups either via a subcostal approach (SC group) or a full sternotomy (FS group). The exclusion criteria of a subcostal approach for device exchange included the presence of outflow graft obstruction, and/or the need for concomitant cardiac procedures. Among 277 consecutive patients who underwent HeartMate II implantation from July 2008 to December 2015, 25 patients (9.0%) required device exchange (SC group; N = 13, FS group; N = 12). The SC group, compared to the FS group, had a shorter operative time (200.6 ± 31.4 min vs 534.2 ± 123.9 min; P < 0.001), shorter cardiopulmonary bypass time (33.1 ± 22.0 min vs 151.5 ± 53.1 min; P < 0.001), fewer blood transfusion (0.31 ± 0.48 units vs 4.67 ± 3.65 units; P = 0.002). The SC group had lower incidence of postoperative prolonged intubation (> 24 h) (7.7% vs 90.9%, P < 0.001), tracheostomy (0.0% vs 41.7%, P = 0.015), acute kidney injury requiring dialysis (0.0% vs 33.3%, P = 0.039). In-hospital mortality was 0.0% (0/13) in the SC group and 16.7% (2/12) in the FS group (P = 0.220). In conclusion, a subcostal approach was associated with shorter operative time, fewer blood transfusions, and less postoperative complications, compared to full sternotomy. A subcostal approach, if feasible, is preferred for HeartMate II device exchange.

• Authors: Hiroto Kitahara, Jayant Raikhelkar, Gene Kim, Nitasha Sarswat, Gabriel Sayer, Nir Uriel, Tae Song, David Onsager, Valluvan Jeevanandam, Takeyoshi Ota
• Journal: Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs (J Artif Organs) Vol. 22 Issue 3 Pg. 181-187 (Sep 2019) ISSN: 1619-0904 [Electronic] Japan
• PMID: 30976935 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Female
• Heart Failure (surgery)
• Heart-Assist Devices
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Operative Time
• Postoperative Complications (etiology)
• Prosthesis Implantation (adverse effects, methods)
• Reoperation
• Retrospective Studies
• Sternotomy