020 * MINIMALLY INVASIVE SURGICAL AND ANAESTHETIC APPROACH FOR VENTRICULAR ASSIST DEVICE IMPLANTATION: A SINGLE-CENTRE EXPERIENCE

Abstract

Purpose: Ventricular assist device (VAD) therapy in heart failure is well established therapy. The hemodynamic fragility of these patients is reported, and renal insufficiency, pulmonary hypertension, and pulmonary disease stand out as risk factors. The aim of our study is to compare two different surgical and anesthetic-analgesic approaches during VAD implantation. Methods: Sixty-eight patients with a mean age of 50.4+/-17.1 years were supported with the HeartWare LVAD (32 patients) and the Jarvik 2000 (36 patients) at our unit from January 2009 to August 2014. Two different surgical techniques were applied: minimally invasive surgical approach with the aid of paravertebral block) (Group A; 41 patients) and standard surgical approach (left thoracotomy and/or full-sternotomy with the aid of general anesthesia) (Group B; 27). Results: The minimally invasive approach allowed a faster post-operative recovery by significantly reducing the duration of surgery (p< 0.05), anesthesia (p< 0.05), mechanical ventilation (half of the patients extubated in OR) (p< 0.05), inotropic support (p< 0.05), and by shortening the ICU and in Hospital stay (p< 0.05), and finally by accelerating the time to first mobilization (p< 0.05). Additionally, a significantly reduced need for plasma and platelet transfusions (p< 0.05) was reported. No case of epidural haematoma was observed. Nine patients required a temporary right ventricular paracorporeal support, further weaned and removed between 48 and 72 hours later, but the cases resulted equally distributed within the two groups (Group A 4 patients, Group B 5 patients). Eleven patients died (16%) at 30 days, 3 in Group A (7.3%) and 8 in Group B (29.6%). Three year survival was 52.21%. Conclusion: Surgical and anesthetic minimally invasive approaches may play a substantial role in VAD surgery favoring faster recovery and shorter hospital length of stay, important when patients at very high risk are considered.