In:
Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. 5 ( 2022-05)
Abstract:
Minimally invasive surgery for left ventricular assist device implantation may have advantages over conventional sternotomy (CS). Additionally, ultra-fast-track anesthesia has been linked to better outcomes after cardiac surgery. This study summarizes our early experience of combining minimally invasive surgery with ultra-fast-track anesthesia (MIFTA) in patients receiving HeartMate 3 devices and compares the outcomes between MIFTA and CS. Methods: From October 2015 to January 2019, 18 of 49 patients with Interagency Registry for Mechanically Assisted Circulatory Support profiles 〉 1 underwent MIFTA for HeartMate 3 implantation. For bias reduction, propensity scores were calculated and used as a covariate in a regression model to analyze outcomes. Weighted parametric survival analysis was performed. Results: In the MIFTA group, intensive care unit stays were shorter (mean difference, 8 days [95% CI, 4–13]; P 〈 0.001), and the incidences of pneumonia and right heart failure were lower than those in the CS group (odds ratio, 1.36 [95% CI, 1.01–1.75]; P =0.016, respectively). At 6 and 12 hours postoperatively, MIFTA patients had a better hemodynamic performance with lower pulmonary wedge pressure (mean difference, 2.23 mm Hg [95% CI, 0.41–4.06]; P =0.028) and a higher right ventricular stroke work index (mean difference, −1.49 g·m/m 2 per beat [95% CI, −2.95 to −0.02]; P =0.031). CS patients had a worse right heart failure–free survival rate (hazard ratio, 2.35 [95% CI, 0.96–5.72]; P 〈 0.01). Conclusions: Compared with CS, MIFTA is a beneficial approach for non–Interagency Registry for Mechanically Assisted Circulatory Support 1 HeartMate 3 patients with lower adverse event incidences, better hemodynamic performance, and preserved right heart function. Future large multicentric investigations are required to verify MIFTA’s effects on outcomes.
Type of Medium:
Online Resource
ISSN:
1941-3289
,
1941-3297
DOI:
10.1161/CIRCHEARTFAILURE.121.008358
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
2428100-1
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