A minimally invasive off-pump implantation technique for continuous-flow left ventricular assist devices: Early experience

BACKGROUND: The HeartWare (HeartWare International, Inc. Framingham, MA) ventricular assist device (HVAD) is approved for implantation through a sternotomy with cardiopulmonary bypass. We report on our initial experience with this device implanted off-pump via thoracotomy. METHODS: A total of 26 patients were included in this review. All patients were Interagency Registry for Mechanically Assisted Circulatory Support categories 2 or 3 and underwent implantation of an HVAD as an elective procedure via thoracotomy and mini sternotomy approach. Three-dimensional echocardiography was used to assess the ventricle and was also used to facilitate proper pump positioning. Patients were managed during follow-up using anti-coagulants at a target international normalized ratio 2.0 to 2.5 as well as anti-platelet agents. RESULTS: Implantation was performed without the use of cardiopulmonary bypass, but 1 patient did require conversion to on-pump surgery. There were no perioperative deaths or right heart failure events. The mean intensive care unit stay was 1.5 days. Transfusions of 1 to 3 units of packed red blood cells were required in 16 patients, whereas 10 patients maintained a stable perioperative hematocrit of at least 30% and did not require transfusion. Survival through 90 days was 100%, and survival through 180 days was 87%. CONCLUSIONS: Our experience was favorable in respect to outcome, safety, and use of blood products. Our technique can be used as an alternative approach for left ventricular assist device implantation using the HVAD. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.