The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes
Background: The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We sought to determine whether the presence of a left ventricular assist device (LVAD) in either location has a meaningful...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2022-06-01
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| Series: | Journal of Chest Surgery |
| Subjects: |
| _version_ | 1811340690696699904 |
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| author | Michael Salna Yuming Ning Paul Kurlansky Melana Yuzefpolskaya Paolo C. Colombo Yoshifumi Naka Koji Takeda |
| author_facet | Michael Salna Yuming Ning Paul Kurlansky Melana Yuzefpolskaya Paolo C. Colombo Yoshifumi Naka Koji Takeda |
| author_sort | Michael Salna |
| collection | DOAJ |
| description | Background: The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago,
IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We
sought to determine whether the presence of a left ventricular assist device (LVAD) in either
location has a meaningful impact on overall patient outcomes.
Methods: A retrospective cohort study was conducted of all 165 patients who received
a HeartMate 3 LVAD via a median sternotomy from November 2014 to August 2019 at our
center. Based on operative reports and imaging, patients were divided into intrapleural
(n=81) and intrapericardial (n=84) cohorts. The primary outcome of interest was in-hospital
mortality, while secondary outcomes included postoperative complications, cumulative
readmission incidence, and 3-year survival.
Results: There were no significant between-group differences in baseline demographics,
risk factors, or preoperative hemodynamics. The overall in-hospital mortality rate was 6%,
with no significant difference between the cohorts (9% vs. 4%, p=0.20). There were no
significant differences in the postoperative rates of right ventricular failure, kidney failure
requiring hemodialysis, stroke, tracheostomy, or arrhythmias. Over 3 years, despite similar
mortality rates, intrapleural patients had significantly more readmissions (n=180 vs. n=117,
p<0.01) with the most common reason being infection (n=68/165), predominantly unrelated
to the device. Intrapleural patients had significantly more infection-related readmissions,
predominantly driven by non-ventricular assist device-related infections (p=0.02),
with 41% of these due to respiratory infections compared with 28% of intrapericardial
patients.
Conclusion: Compared with intrapericardial placement, insertion of an intrapleural HM3
may be associated with a higher incidence of readmission, especially due to respiratory
infection. |
| first_indexed | 2024-04-13T18:45:39Z |
| format | Article |
| id | doaj.art-cb94cc638bd944b290742deada115b7d |
| institution | Directory Open Access Journal |
| issn | 2765-1606 2765-1614 |
| language | English |
| last_indexed | 2024-04-13T18:45:39Z |
| publishDate | 2022-06-01 |
| publisher | Korean Society for Thoracic & Cardiovascular Surgery |
| record_format | Article |
| series | Journal of Chest Surgery |
| spelling | doaj.art-cb94cc638bd944b290742deada115b7d2022-12-22T02:34:35ZengKorean Society for Thoracic & Cardiovascular SurgeryJournal of Chest Surgery2765-16062765-16142022-06-0155319720510.5090/jcs.21.148The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical OutcomesMichael Salna0https://orcid.org/0000-0002-0565-6485Yuming Ning1https://orcid.org/0000-0002-0666-4145Paul Kurlansky2https://orcid.org/0000-0003-2681-9885Melana Yuzefpolskaya3https://orcid.org/0000-0003-4729-8943Paolo C. Colombo4https://orcid.org/0000-0001-5675-5443Yoshifumi Naka5https://orcid.org/0000-0003-1808-7063Koji Takeda6https://orcid.org/0000-0001-8263-1911Columbia University Irving Medical CenterColumbia University Irving Medical CenterColumbia University Irving Medical CenterColumbia University Irving Medical CenterColumbia University Irving Medical CenterColumbia University Irving Medical CenterColumbia University Irving Medical CenterBackground: The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We sought to determine whether the presence of a left ventricular assist device (LVAD) in either location has a meaningful impact on overall patient outcomes. Methods: A retrospective cohort study was conducted of all 165 patients who received a HeartMate 3 LVAD via a median sternotomy from November 2014 to August 2019 at our center. Based on operative reports and imaging, patients were divided into intrapleural (n=81) and intrapericardial (n=84) cohorts. The primary outcome of interest was in-hospital mortality, while secondary outcomes included postoperative complications, cumulative readmission incidence, and 3-year survival. Results: There were no significant between-group differences in baseline demographics, risk factors, or preoperative hemodynamics. The overall in-hospital mortality rate was 6%, with no significant difference between the cohorts (9% vs. 4%, p=0.20). There were no significant differences in the postoperative rates of right ventricular failure, kidney failure requiring hemodialysis, stroke, tracheostomy, or arrhythmias. Over 3 years, despite similar mortality rates, intrapleural patients had significantly more readmissions (n=180 vs. n=117, p<0.01) with the most common reason being infection (n=68/165), predominantly unrelated to the device. Intrapleural patients had significantly more infection-related readmissions, predominantly driven by non-ventricular assist device-related infections (p=0.02), with 41% of these due to respiratory infections compared with 28% of intrapericardial patients. Conclusion: Compared with intrapericardial placement, insertion of an intrapleural HM3 may be associated with a higher incidence of readmission, especially due to respiratory infection.left ventricular assist deviceheart failurepleural space |
| spellingShingle | Michael Salna Yuming Ning Paul Kurlansky Melana Yuzefpolskaya Paolo C. Colombo Yoshifumi Naka Koji Takeda The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes Journal of Chest Surgery left ventricular assist device heart failure pleural space |
| title | The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes |
| title_full | The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes |
| title_fullStr | The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes |
| title_full_unstemmed | The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes |
| title_short | The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes |
| title_sort | impact of intrapericardial versus intrapleural heartmate 3 pump placement on clinical outcomes |
| topic | left ventricular assist device heart failure pleural space |
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