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J Chest Surg

Published online April 28, 2022

Copyright © Journal of Chest Surgery.

The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes

Michael Salna, M.D.1 , Yuming Ning, Ph.D.2 , Paul Kurlansky, M.D.1 , Melana Yuzefpolskaya, M.D.3 , Paolo C. Colombo, M.D.3 , Yoshifumi Naka, M.D., Ph.D.1 , Koji Takeda, M.D., Ph.D.1

1Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, 2Center for Innovation and Outcomes Research, Department of Surgery, and 3Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

Correspondence to:Koji Takeda
Tel 1-212-305-5156
E-mail kt2485@cumc.columbia.edu
ORCID
https://orcid.org/0000-0001-8263-1911

Received: December 13, 2021; Revised: January 24, 2022; Accepted: March 2, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Left ventricular assist device, Heart failure, Pleural space

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J Chest Surg

Published online April 28, 2022

Copyright © Journal of Chest Surgery.

The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes

Michael Salna, M.D.1 , Yuming Ning, Ph.D.2 , Paul Kurlansky, M.D.1 , Melana Yuzefpolskaya, M.D.3 , Paolo C. Colombo, M.D.3 , Yoshifumi Naka, M.D., Ph.D.1 , Koji Takeda, M.D., Ph.D.1

1Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, 2Center for Innovation and Outcomes Research, Department of Surgery, and 3Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

Correspondence to:Koji Takeda
Tel 1-212-305-5156
E-mail kt2485@cumc.columbia.edu
ORCID
https://orcid.org/0000-0001-8263-1911

Received: December 13, 2021; Revised: January 24, 2022; Accepted: March 2, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Left ventricular assist device, Heart failure, Pleural space

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