The researchers noted there seemed to be some benefits of performing minimally invasive surgery for implanting left ventricular assist devices over conventional sternotomy (CS). Moreover, they found links between better results and the use of ultra-fast-track anesthesia after cardiac surgery. Their research outlined the early experience of utilizing a combination of minimally invasive surgery with ultra-fast-track anesthesia (MIFTA) in patients who received HeartMate 3 devices. It also compared the results between MIFTA and CS.
Of the 49 patients with Interagency Registry for Mechanically Assisted Circulatory Support profiles more than 1, a surgeon implanted HeartMate 3 devices in 18 patients. The researchers calculated propensity scores to reduce bias. They used those scores as covariates in a regression model to examine the results. They also performed weighted parametric survival analysis.
The patient stays in the intensive care unit were shorter (mean difference, 8 days [95% CI, 4–13]; P<0.001) in the MIFTA group. And compared to the CS group, the occurrences of pneumonia and right heart failure were lower in the MIFTA group (odds ratio, 1.36 [95% CI, 1.01–1.75]; P=0.016, respectively). The MIFTA patients demonstrated better hemodynamic performance with lower pulmonary wedge pressure (mean difference, 2.23 mm Hg [95% CI, 0.41–4.06]; P=0.028) and a higher right ventricular stroke work index (mean difference, −1.49 g·m/m2 per beat [95% CI, −2.95 to −0.02]; P=0.031) when measured at 6 and 12 hours of postoperative care. In contrast, CS patients demonstrated a worse right heart failure-free survival rate (hazard ratio, 2.35 [95% CI, 0.96–5.72]; P<0.01).
The researchers concluded that MIFTA is a promising approach for non–Interagency Registry for Mechanically Assisted Circulatory Support 1 HeartMate 3 patients. MIFTA demonstrated improved hemodynamic performance, the scope of adverse events was low, and it preserved right heart function compared to CS. They also highlighted that further large-scale multicentric analysis was essential to judge the effects of MIFTA on results.
Link:www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008358
