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Schmitto JD, Mariani S, Abicht TO, Couper GS, Danter MR, Itoh A, Khalpey Z, Kon ZN, Maltais S, Mokadam NA, Pham DT, Popov AF, Saeed D, Simon AR, Zimpfer D, Strueber M. Expert Consensus Paper: Lateral Thoracotomy for Centrifugal Ventricular Assist Device Implant. Ann Thorac Surg 2020; 112:1687-1697. [PMID: 33309728 DOI: 10.1016/j.athoracsur.2020.09.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The increasing prevalence of heart failure has led to the expanded use of left ventricle assist devices (VADs) for end-stage heart failure patients worldwide. Technological improvements witnessed the development of miniaturized VADs and their implantation through less traumatic non-full sternotomy approaches using a lateral thoracotomy (LT). Although adoption of the LT approach is steadily growing, a lack of consensus remains regarding patient selection, details of the surgical technique, and perioperative management. Furthermore, the current literature does not offer prospective randomized studies or evidence-based guidelines for LT-VAD implantation. METHODS A worldwide group of LT-VAD experts was convened to discuss these key topics openly. After a PubMed search and review with all authors, a consensus was reached and an expert consensus paper on LT-VAD implantation was developed. RESULTS This document aims to guide clinicians in the selection of patients suitable for LT approaches and preoperative optimization. Details of operative techniques are described, with an overview of hemisternotomy and bilateral thoracotomy approaches. A review of the best surgical practices for placement of the pump, inflow cannula, and outflow graft provides advice on the best surgical strategies to avoid device malpositioning while optimizing VAD function. Experts' opinions on cardiopulmonary bypass, postoperative management, and approaches for pump exchange and explant are presented. This review also emphasizes the critical need for multidisciplinary teams and specific training. CONCLUSIONS This expert consensus review provides a compact guide to LT for VAD implantation, from patient selection through intraoperative tips and postoperative management.
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Affiliation(s)
- Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany.
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Travis O Abicht
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Gregory S Couper
- Department of Cardiovascular Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Matthew R Danter
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Akinobu Itoh
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Zain Khalpey
- Department of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Simon Maltais
- Department of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montréal, Québec, Canada
| | - Nahush A Mokadam
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aron Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - Diyar Saeed
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - André R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Strueber
- Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, Newark, New Jersey
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Gallo M, Spigolon L, Bejko J, Gerosa G, Bottio T. How to evaluate the outflow tract of LVAD after minimally invasive implantation by 3D CT-scan. Artif Organs 2020; 44:1306-1309. [PMID: 32668042 DOI: 10.1111/aor.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 12/27/2022]
Abstract
During a minimally invasive implantation technique, the outflow graft of left ventricular assist device (LVAD) is tunnelled blindly through the pericardium or left pleura, with an inability to assess for twisting or malposition. Three-dimensional computed tomography scan (CT-scan) has a role in qualitative evaluation of the different outflow tract configurations. The different surgical minimally invasive approaches include: (a) mini-sternotomy and left mini-thoracotomy, (b) right mini-thoracotomy and left mini-thoracotomy, (c) subclavian artery access and left mini-thoracotomy. The outflow graft could be anastomosed to the left axillary artery or the ascending aorta. CT-scan reconstruction using syngo InSpace4D (Siemens, Muenchen, Germany) was used to provide fast segmentation and high-resolution images. The 3D reconstructions permit an evaluation of different anastomosis configurations and to assess the route of outflow graft.
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Affiliation(s)
- Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland.,Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Luca Spigolon
- Division of Radiology, Vicenza Hospital, Vicenza, Italy
| | - Jonida Bejko
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Tomaso Bottio
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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