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A subcostal approach is favorable compared to sternotomy for left ventricular assist device exchange field of research: artificial heart (clinical)

  • Hiroto Kitahara
  • Jayant Raikhelkar
  • Gene Kim
  • Nitasha Sarswat
  • Gabriel Sayer
  • Nir Uriel
  • Tae Song
  • David Onsager
  • Valluvan Jeevanandam
  • Takeyoshi OtaEmail author
Original Article Artificial Heart (Clinical)
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Abstract

This is a single-center retrospective study to summarize clinical outcomes of patients requiring surgical continuous-flow left ventricular assist device (HeartMate II) exchange. The patients who underwent HeartMate II exchange were divided into two groups either via a subcostal approach (SC group) or a full sternotomy (FS group). The exclusion criteria of a subcostal approach for device exchange included the presence of outflow graft obstruction, and/or the need for concomitant cardiac procedures. Among 277 consecutive patients who underwent HeartMate II implantation from July 2008 to December 2015, 25 patients (9.0%) required device exchange (SC group; N = 13, FS group; N = 12). The SC group, compared to the FS group, had a shorter operative time (200.6 ± 31.4 min vs 534.2 ± 123.9 min; P < 0.001), shorter cardiopulmonary bypass time (33.1 ± 22.0 min vs 151.5 ± 53.1 min; P < 0.001), fewer blood transfusion (0.31 ± 0.48 units vs 4.67 ± 3.65 units; P = 0.002). The SC group had lower incidence of postoperative prolonged intubation (> 24 h) (7.7% vs 90.9%, P < 0.001), tracheostomy (0.0% vs 41.7%, P = 0.015), acute kidney injury requiring dialysis (0.0% vs 33.3%, P = 0.039). In-hospital mortality was 0.0% (0/13) in the SC group and 16.7% (2/12) in the FS group (P = 0.220). In conclusion, a subcostal approach was associated with shorter operative time, fewer blood transfusions, and less postoperative complications, compared to full sternotomy. A subcostal approach, if feasible, is preferred for HeartMate II device exchange.

Keywords

Left ventricular assist device Thrombosis Device exchange 

Notes

Compliance with ethical standards

Conflict of interest

Dr Valluvan Jeevanandam discloses that he receives consultant fees from Abbott. Dr Nir Uriel discloses that he receives consultant fees and grant supports from Abbott, and Medtronic.

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Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  • Hiroto Kitahara
    • 1
  • Jayant Raikhelkar
    • 2
  • Gene Kim
    • 2
  • Nitasha Sarswat
    • 2
  • Gabriel Sayer
    • 2
  • Nir Uriel
    • 2
  • Tae Song
    • 1
  • David Onsager
    • 1
  • Valluvan Jeevanandam
    • 1
  • Takeyoshi Ota
    • 1
    Email author
  1. 1.Department of Surgery, Section of Cardiac and Thoracic SurgeryThe University of Chicago MedicineChicagoUSA
  2. 2.Department of Medicine, Section of CardiologyThe University of Chicago MedicineChicagoUSA

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