Axial to Centrifugal Continuous Flow LVAD Pump Exchange Using Minimally Invasive Technique

Driveline or device infection may complicate left ventricular assist device implants, and only curative option may be pump exchange. Replacement with similar device may be liable to reinfection, because pump configuration is such that the new device and driveline may partly lie within the pocket of the previous pump. One approach to overcome this is using a different pump design such that the new pump would lie in a different location from the old pump. We describe treatment of severe HeartMate II (Abbott, [St Jude Thoratec Corp], Pleasanton, CA USA) left ventricular assist device infection by minimally invasive exchange to an intrapericardial HVAD (HeartWare International, Inc, Framingham, MA USA) left ventricular assist device.

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Left Ventricular Assist Device Infection Is Associated With Increased Mortality but Is Not a Contraindication to Transplantation

Circulation ◽

10.1161/01.cir.95.4.814 ◽

1997 ◽

Vol 95 (4) ◽

pp. 814-817 ◽

Cited By ~ 113

Author(s):

Mathias Herrmann ◽

Michael Weyand ◽

Britta Greshake ◽

Christof von Eiff ◽

Richard A. Proctor ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Device Infection ◽

Left Ventricular Assist

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Minimally Invasive Left Ventricular Assist Device Insertion Facilitates Subsequent Heart Transplant

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520980409 ◽

2021 ◽

pp. 155698452098040

Author(s):

Joseph Rabin ◽

Luke A. Ziegler ◽

Sarah Cipriano ◽

Ronson J. Madathil ◽

Erika D. Feller ◽

...

Keyword(s):

Minimally Invasive ◽

Left Ventricular Assist Device ◽

Heart Transplant ◽

Ventricular Assist Device ◽

Cardiac Transplantation ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Ischemic Time ◽

Left Ventricular Assist

Objective We have observed that minimally invasive left ventricular assist device (LVAD) insertion leads to more facile re-entry and easier cardiac transplantation. We hypothesize minimally invasive LVAD implantation results in improved outcomes at the time of subsequent heart transplant. Methods All adults undergoing cardiac transplantation between October 2015 and March 2019 at our institution were retrospectively reviewed. Those bridged to transplantation with a HeartWare HVAD were identified and divided into 2 cohorts based upon the surgical approach: those who underwent HVAD placement by conventional sternotomy versus minimally invasive insertion via lateral thoracotomy and hemisternotomy (LTHS). Patient demographics, as well as perioperative transplant outcomes, including survival, length of stay (LOS), blood utilization, ischemic time, bypass time, and postoperative extracorporeal membrane oxygenation (ECMO) were compared between cohorts. Results Forty-two patients were bridged to heart transplant with a HVAD implanted via either sternotomy ( n = 22) or LTHS technique ( n = 20). Demographics were similar between groups. There was 1 predischarge death in the sternotomy group and none in the LTHS group. Body surface area, cardiopulmonary bypass time, ischemic time, ECMO utilization, and reoperation for bleeding were similar. Red blood cell units transfused were significantly lower in the LTHS cohort (3.0 [1.0-5.0] vs 6.0 [2.5-10.0] P = 0.046). The LTHS cohort had a significantly shorter hospital LOS (12.0 [11.0-28.0] vs 22.5 [15.7-41.7] P = 0.022) with a trend toward shorter intensive care unit LOS (6.0 [5.0-10.5] vs 11.0 [6.0-21.5] days P = 0.057). Conclusions Minimally invasive HVAD implantation improves outcomes at subsequent heart transplantation, resulting in shorter LOS and less red cell transfusion. Larger multi-institutional studies are necessary to validate these findings.

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