Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:13-7 - Vol. 71 Num.01 DOI: 10.1016/j.rec.2017.03.023

Left Ventricular Assist Device Therapy for Destination Therapy: Is Less Invasive Surgery a Safe Alternative?

Sebastian V. Rojas a,, Jasmin S. Hanke a, Murat Avsar a, Philipp R. Ahrens a, Ove Deutschmann a, Kirstin A. Tümler a, Aitor Uribarri a,b, Sara Rojas-Hernández c, Pedro L. Sánchez b, José M. González-Santos d, Axel Haverich a, Jan D. Schmitto a

a Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
b Departamento de Cardiología, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
c Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
d Departamento de Cirugía Cardiaca, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain

Refers to

Keywords

Left ventricular assist device. Mechanical circulatory support. Minimally invasive. Less invasive. Surgical technique. Destination therapy.

Abstract

Introduction and objectives

The number of older patients with congestive heart failure has dramatically increased. Because of stagnating cardiac transplantation, there is a need for an alternative therapy, which would solve the problem of insufficient donor organ supply. Left ventricular assist devices (LVADs) have recently become more commonly used as destination therapy (DT). Assuming that older patients show a higher risk-profile for LVAD surgery, it is expected that the increasing use of less invasive surgery (LIS) LVAD implantation will improve postoperative outcomes. Thus, this study aimed to assess the outcomes of LIS-LVAD implantation in DT patients.

Methods

We performed a prospective analysis of 2-year outcomes in 46 consecutive end-stage heart failure patients older than 60 years, who underwent LVAD implantation (HVAD, HeartWare) for DT in our institution between 2011 and 2013. The patients were divided into 2 groups according to the surgical implantation technique: LIS (n = 20) vs conventional (n = 26).

Results

There was no statistically significant difference in 2-year survival rates between the 2 groups, but the LIS group showed a tendency to improved patient outcome in 85.0% vs 69.2% (P = .302). Moreover, the incidence of postoperative bleeding was minor in LIS patients (0% in the LIS group vs 26.9% in the conventional surgery group, P < .05), who also showed lower rates of postoperative extended inotropic support (15.0% in the LIS group vs 46.2% in the conventional surgery group, P < .05).

Conclusions

Our data indicate that DT patients with LIS-LVAD implantation showed a lower incidence of postoperative bleeding, a reduced need for inotropic support, and a tendency to lower mortality compared with patients treated with the conventional surgical technique.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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