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Combining Minimally Invasive Surgery With Ultra-Fast-Track Anesthesia in HeartMate 3 Patients: A Pilot Study.
Usaama Ahmad1, Mohammad Amen Khattab1, Gereon Schaelte2
1Faculty of Medicine, Department of Thoracic and Cardiovascular Surgery (U.A., M.A.K., A.M., L.T., R.A., H.S., R.Z.), RWTH University Hospital Aachen, RWTH Aachen University, Germany.
Minimally invasive surgery with ultra-fast-track anesthesia (MIFTA) for HeartMate 3 implantation shows improved outcomes compared to conventional sternotomy (CS). MIFTA reduces intensive care unit stays and adverse events, offering better hemodynamic performance and preserved right heart function.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Anesthesiology
Background:
- Minimally invasive surgery (MIS) may offer advantages over conventional sternotomy (CS) for left ventricular assist device (LVAD) implantation.
- Ultra-fast-track anesthesia is associated with improved outcomes in cardiac surgery.
- This study evaluates the combination of MIS and ultra-fast-track anesthesia (MIFTA) for HeartMate 3 LVAD implantation.
Purpose of the Study:
- To compare the outcomes of MIFTA with CS for HeartMate 3 LVAD implantation.
- To assess the early experience and efficacy of the combined MIFTA approach.
Main Methods:
- Retrospective analysis of 18 patients undergoing MIFTA for HeartMate 3 implantation (October 2015 - January 2019).
- Propensity score matching was used to minimize bias between MIFTA and CS groups.
- Weighted parametric survival analysis was performed to compare outcomes.
Main Results:
- MIFTA group showed significantly shorter intensive care unit (ICU) stays (8 days shorter) and lower incidences of pneumonia and right heart failure compared to CS.
- MIFTA patients exhibited better postoperative hemodynamic performance, including lower pulmonary wedge pressure and higher right ventricular stroke work index.
- Conventional sternotomy (CS) patients had a worse right heart failure-free survival rate.
Conclusions:
- MIFTA is a beneficial approach for HeartMate 3 LVAD implantation in selected patients (non-Interagency Registry for Mechanically Assisted Circulatory Support 1).
- MIFTA is associated with reduced adverse events, improved hemodynamics, and preserved right heart function compared to CS.
- Further large-scale multicentric studies are needed to confirm these findings.
