Temporary ventricular assist device implantation by sternotomy-avoiding technique for bridge-to-decision therapy: a comparison with conventional implantation

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Abstract

Objective: Temporary ventricular assist device (VAD) is a commonly used therapeutic option for cardiogenic shock. Patients requiring this treatment are often critical, and clinical outcomes remain unsatisfactory. This study evaluated the feasibility and efficacy of a sternotomy-avoiding technique for temporary VAD implantation to improve patient outcomes. Methods: Between December 2012 and November 2018, seven patients underwent temporary VAD implantation by sternotomy-avoiding technique (SA group) and eight by median sternotomy technique (MS group). Pre- and intraoperative characteristics, postoperative 7-day hemodynamic parameters, 30-day mortality, and adverse events were compared between the groups. Results: More than 50% of the patients were mechanically supported before temporary VAD implantation. Cardiopulmonary bypass time was significantly shorter in the SA than in the MS group (84 min vs 215 min; p = 0.011); surgical time tended to be shorter in the SA group (385 min vs 461 min; p = 0.064). Pump index, cardiac index, mixed venous oxygen saturation, and central venous pressure did not differ significantly during the first seven days of support. The 30-day incidence of any adverse event was not significantly different between the groups. No patients in the SA group needed re-exploration for surgical bleeding. Thirty-day all-cause mortality rates were 29% in the SA group and 0% in the MS group (p = 0.11). Conclusions: The sternotomy-avoiding and conventional techniques resulted in comparable short-term hemodynamic support. The sternotomy-avoiding technique was associated with a potential reduction in risk of re-exploration for bleeding. These results support the usefulness of the sternotomy-avoiding procedure for selected patients.

Original languageEnglish
Pages (from-to)240-247
Number of pages8
JournalGeneral thoracic and cardiovascular surgery
Volume68
Issue number3
DOIs
Publication statusPublished - 2020 Mar 1

Keywords

  • Bridge to decision
  • Cardiogenic shock
  • Temporary ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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