A pilot study on the efficacy and safety of a minimally invasive surgical and anesthetic approach for ventricular assist device implantation

Jonida Bejko; Demetrio Pittarello; Gianclaudio Falasco; Guido Di Gregorio; Vincenzo Tarzia; Giulio Rizzoli; Dario Gregori; Gino Gerosa; Tomaso Bottio

doi:10.5301/ijao.5000647

A pilot study on the efficacy and safety of a minimally invasive surgical and anesthetic approach for ventricular assist device implantation

Int J Artif Organs. 2017 Oct 16:0. doi: 10.5301/ijao.5000647. Online ahead of print.

Authors

Jonida Bejko¹, Demetrio Pittarello², Gianclaudio Falasco², Guido Di Gregorio², Vincenzo Tarzia¹, Giulio Rizzoli¹, Dario Gregori¹, Gino Gerosa¹, Tomaso Bottio¹

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy.
² Department of Medicine Anesthesiology, University of Padua, Padua - Italy.

PMID: 29048703
DOI: 10.5301/ijao.5000647

Abstract

Background: The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation.

Methods: 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients).

Results: The minimally invasive approach allowed faster postoperative recovery by significantly reducing the duration of surgery (p<0.05), anesthesia (p<0.05), mechanical ventilation (p<0.05), inotropic support (p<0.05), ICU and in-hospital stay (p<0.05), and time to first mobilization (p<0.05). No case of epidural hematoma was observed. Eleven patients died (16%) at 30 days, 3 in the mini-invasive group (7.3%) and 8 in the invasive group (29.6%).

Conclusions: Minimally invasive approaches play a substantial role in VAD surgery by facilitating faster recovery, which is important for patients at very high risk.