PMID- 30034841 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220318 IS - 2072-1439 (Print) IS - 2077-6624 (Electronic) IS - 2072-1439 (Linking) VI - 10 IP - Suppl 15 DP - 2018 Jun TI - Minimally invasive surgery improves outcome of left ventricular assist device surgery in cardiogenic shock. PG - S1696-S1702 LID - 10.21037/jtd.2018.01.27 [doi] AB - BACKGROUND: Left ventricular assist device (LVAD) (HVAD, Medtronic, Minneapolis, MN, USA) implantation is already a widely accepted treatment option for end-stage heart failure (HF) but also still considered as a rescue therapy for patients suffering from cardiogenic shock. Standard LVAD implantation techniques are often associated with high mortality rates and can result in severe complications, like bleeding or right heart failure (RHF). The aim of our study was to assess the outcome of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients (so called "crash and burn" patients) undergoing a LVAD implantation by standard or less invasive surgery. METHODS: We performed a retrospective evaluation of the 1-year outcome of 32 consecutive HF patients in cardiogenic shock, who underwent LVAD implantation in our institution. A total of 32 INTERMACS 1 patients were emergently operated. Fourteen patients (group A) were operated by using the "Hannover-VAD-technique", which is widely known to be less invasive (upper hemisternotomy and a left-sided anterolateral thoracotomy). In contrast, 18 patients (group B) were implanted with LVAD by using the standard technique (full sternotomy). The primary endpoint was survival after 1 year without device-related re-operations. Secondary endpoints included combined analyses of rates of RHF, respiratory failure and bleeding during the trial period. RESULTS: Baseline characteristics were similar in both groups. Survival after 1 year was higher in group A (69.7% vs. 50.0%). Technique-related adverse events (AEs) were also lower in the minimally invasive group, including a lower RHF (35.7% vs. 61.1%) and of further postoperative bleeding requiring surgery (14.3% vs. 33.3%). CONCLUSIONS: LVAD surgery in INTERMACS 1 patients is associated with remarkably good outcome considering the already very high mortality of those patients, and compared to previously reported surgical outcomes. Our study indicates that minimally invasive LVAD implantation in cardiogenic shock decreases mortality and the incidence of postoperative AEs. FAU - Wert, Leonhard AU - Wert L AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Chatterjee, Anamika AU - Chatterjee A AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Dogan, Gunes AU - Dogan G AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Hanke, Jasmin S AU - Hanke JS AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Boethig, Dietmar AU - Boethig D AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Tumler, Kirstin A AU - Tumler KA AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Napp, L Christian AU - Napp LC AD - Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. FAU - Berliner, Dominik AU - Berliner D AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Feldmann, Christina AU - Feldmann C AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Kuehn, Christian AU - Kuehn C AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Martens, Andreas AU - Martens A AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Shrestha, Malakh L AU - Shrestha ML AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Haverich, Axel AU - Haverich A AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. FAU - Schmitto, Jan D AU - Schmitto JD AD - Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. LA - eng PT - Journal Article PL - China TA - J Thorac Dis JT - Journal of thoracic disease JID - 101533916 PMC - PMC6035957 OTO - NOTNLM OT - Left ventricular assist device (LVAD) OT - cardiogenic shock OT - less invasive OT - mechanical circulatory support OT - minimally invasive OT - surgical technique COIS- Conflicts of Interest: JD Schmitto and G Dogan are consultants of Medtronic; LC Napp received lecture honoraria from Abiomed and Maquet. The other authors have no conflicts of interest to declare. EDAT- 2018/07/24 06:00 MHDA- 2018/07/24 06:01 PMCR- 2018/06/01 CRDT- 2018/07/24 06:00 PHST- 2018/07/24 06:00 [entrez] PHST- 2018/07/24 06:00 [pubmed] PHST- 2018/07/24 06:01 [medline] PHST- 2018/06/01 00:00 [pmc-release] AID - jtd-10-S15-S1696 [pii] AID - 10.21037/jtd.2018.01.27 [doi] PST - ppublish SO - J Thorac Dis. 2018 Jun;10(Suppl 15):S1696-S1702. doi: 10.21037/jtd.2018.01.27.