In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device

J Heart Lung Transplant. 2015 Jan;34(1):107-112. doi: 10.1016/j.healun.2014.09.023. Epub 2014 Sep 28.


Background: Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy.

Methods: Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores.

Results: Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups.

Conclusions: An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach.

Keywords: heart failure; left thoracotomy; left ventricular assist device; off-pump surgery; peri-operative outcomes; surgical approach.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Heart Failure / mortality
  • Heart Failure / surgery*
  • Heart Transplantation
  • Heart-Assist Devices*
  • Hospital Mortality / trends
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Minimally Invasive Surgical Procedures / mortality
  • Retrospective Studies
  • Thoracotomy / methods*
  • Thoracotomy / mortality
  • United States / epidemiology
  • Waiting Lists / mortality
  • Young Adult