Is it Possible to Implant HeartMate 3 Less Invasively? New Pump, New Approach

HeartMate 3 (HM3) left ventricular assist device (LVAD) is a compact, intrapericardial, centrifugal flow pump with a fully magnetically levitated rotor and a wide range of operation (2-10 L/min) to accommodate a broad range of clinical needs. We analyzed our experience with Heartware VAD (HVAD) and HM3 implantation through minimally invasive left thoracotomy (MILT) and upper minimal J sternotomy. Between March 2015 and October 2016, 31 patients who underwent LVAD implantation through MILT were included in this study. Twenty-three patients had HVAD (Group A) implantation, whereas 8 patients had HM3 (Group B). To compare outcomes of these pumps, measures were; mortality, cardiopulmonary bypass (CPB) time, duration of mechanical ventilatory support, blood loss and transfusion, intensive care unit (ICU) stay, right ventricular failure (RVF) and requirement of support with temporary devices, stroke, pump thrombosis, gastrointestinal bleeding and driveline infection rates. Interagency Registry for Mechanically Assisted Circulatory Support profiles, Pennsylvania and Michigan Risk Scores, right ventricular stroke work index and central venous pressure/pulmonary capillary wedge pressure ratio did not differ between these two groups. There was no difference in the length of ICU stay (P = 0.056), post-operative blood product administration (P = 0.701), total time on mechanical ventilation (P = 0.386), RVF (P = 1) or duration of CPB (P = 0.836). In-hospital cerebrovascular event rate was 13% in Group A and 0% in Group B, respectively. The HM3 assist system can be successfully implanted with minimally invasive techniques. This technique has proved to be safe and reproducible, with good clinical outcomes. Further, large collaborative studies are needed to identify the advantages of this approach.