Minimally-invasive approach for left ventricular assist device implantation: Lower mortality and improved early outcome in adult patients with severe heart failure

Objectives: Left ventricular assist devices (LVAD) are gaining more importance in the treatment of heart failure. The constant development of novel technologies in this field is being reflected by enhanced and considerably miniaturized LVAD-systems. However from a surgical point of view, complications like bleeding or right ventricular failure with liver impairment are still major hurdles in LVAD-therapy. Therefore, we recently developed a novel minimally invasive LVAD implantation technique in order to minimize complication rates and improve operative outcome.

Methods: We reviewed the early outcome of 100 consecutive end-stage heart failure patients (74% male, age 51.6 ± 12.6, DCM 49%, ICM 36%) who recently underwent LVAD (HVAD, HeartWare, USA) implantation in our institution between 2011 and 2012. Patients who were operated conventionally by a median sternotomy (group A; n = 65) were compared to patients receiving a minimal invasive upper hemisternotomy combined with an anterolateral thoracotomy (group B; n = 35).

Results: Intra-hospital-mortality was lower in group B (12.3% vs. 8.6%). ICU stay was significantly lower (p < 0.05) in group B (20.2 ± 4.9 days vs. 9.8 ± 2.7 days). Bleeding incidence was also significantly (p < 0.05) lower in group B (18.5% vs. 5.7%). Postoperative glutamate dehydrogenase (GLDH) levels were also significantly (p < 0.05) lower in group B (76.2 ± 238.5 U/L vs. 15.5 ± 52.1 U/L). None of the patients had a pump thrombosis.

Conclusions: Our data show that the applied minimally invasive LVAD-implantation technique improves the early postoperative outcome by improving survival and reducing bleeding events, liver impairment and postoperative ICU stay of terminal heart failure patients.