Combining Ultrafast Anaesthesia and Minimal Invasive Implantation in HeartMate 3: A Pilot Study

PURPOSE Minimally invasive implantation of left ventricular assist devices (MIC-LVAD) is believed to imply several benefits, like less right heart failure (RHF), low respiratory morbidity, and faster convalescence. Additionally, there is some evidence thatultrafast track anaesthesia (UFTA) is associated with fewer postoperative complications. In this study we present our MIC-UFTA approach in HeartMate3 implantation in comparison to the conventional technique through median sternotomy (CS). METHODS We reviewed the midterm outcome of 45 patients who underwent HeartMate3 implantation in two European centres between January, 2016 and 2019. Since February 2018 we changed our LVAD management and aimed to perform the MIC-UFTA approach in all LVAD candidates. We compared our first 15 HM3-patients receiving MIC-UFTA with left-right mini-anterolateral thoracotomy (n = 15) with our last CS HM3-patient (n = 30). RESULTS Mean age was 61±7years. All patients in the MIC-UFTA group had successful extubation in the OR. Median duration of mechanical ventilation in the CS group was 62h (max.144h, min. 6h). Multivariate analysis revealed statistically significant reduction in ICU-stay, days on inotropes and total hospital LOS in the MIC-UFTA (p<0.01). Re-operation due to bleeding was similar between groups. Patients in MIC-UFTA had significantly lower incidence of delirium, pneumonia and RHF as well as requirements of temporary postoperative RVAD-implantation compared to patients in the CS group (p<0.05). At ICU admission central venous pressure (CVP), pulmonary wedge pressure (PWP), pulmonary artery pulse index (PAPi) and cardiac index (CI) did not differ between groups. Yet at 6h and 12h postoperatively CI was significantly higher in the MIC-UFTA group on the contrary PAPi, PWP and CVP were significantly lower compared to CS group (p<0.05). However, 24h postoperatively CVP and CI did not differ significantly between the groups. 1-year survival was significantly higher in MIC-UFTA group (log-Rank p= 0.035). CONCLUSION The MIC-UFTA strategy can be utilized as a safe approach for patients undergoing HM3 implantation. The MIC-UFTA is associated with lower postoperative complications and better hemodynamic performance in the early postoperative period. Further large collaborative studies are needed to confirm advantages of MIC-UFTA approach.