Newly FDA-approved procedure for implanting heart pump helps reduce length of hospital stay

Artel Thorpe Sr. of Jackson, Tennessee, recently became the first person in the United States to undergo a new, less invasive surgical technique for implanting a left ventricular assist device (LVAD) heart pump since it was granted Federal Drug Administration (FDA) approval on July 11.

The surgery, performed at Vanderbilt University Medical Center, allowed Thorpe to avoid having his sternum cut open, instead receiving the implant through much smaller incisions in his upper chest and in the left side of his chest between his ribs.

The new approach to implanting the device via thoracotomy has been demonstrated to be safe and offers several proposed benefits when compared with implantation via sternotomy.

These include reduced length of hospital stay, on average from 26 days down to 18 days, and improved health-related quality of life when compared to implanting it via sternotomy.

The surgery occurred on July 13, two days after the FDA approved the new approach for implanting a HeartWare HVAD, a left ventricular assist device manufactured by Medtronic.

Suffering from congestive heart failure, Thorpe said he didn't let fear stand in the way of treatment.

"I just wanted to get out of the pain," he said, describing angina along with shortness of breath and other debilitating symptoms.

He was running out of time. He had originally been scheduled to have a heart pump implanted at another hospital, but because of health insurance issues he was transferred to VUMC.

"The next thing I know, I'm here," Thorpe said. "Thank the Lord, I'm here."

Matthew Danter, MD, assistant professor of Cardiac Surgery, was his surgeon.

"He was a very high-risk patient," Danter said. "He was requiring multiple drugs to keep his heart moving, and had no other options. He was quite ill at the time of the implant."

Although it was a newly FDA-approved procedure, Danter had actually done the surgery multiple times as part of the landmark HVAD LATERAL trial.

VUMC was the largest enrolling center of the 26 medical centers in the United States and Canada involved in this clinical trial that led to FDA approval.

Danter said the benefits of the procedure extend to when these patients may eventually undergo heart transplant.

"The surgical benefit is you avoid having to reopen the whole sternum again for the LVAD implant," Danter said. "Every time you have to reenter a place that you have already operated on, there's extra risk for injuries. There is the risk of bleeding, there's the risk of damaging the underlying structure. I think that if you can avoid completely opening the sternum fully prior to transplant, it makes the re-entry at the time of transplant less difficult. And when you are the second-busiest heart transplant center in the nation, every little bit helps."

Vanderbilt Cardiac Surgery has a history of pioneering new procedures and is one of the nation's leading heart hospitals as measured by the volume of high-risk patients served and patient survival.

Vanderbilt is also the second largest heart transplant center in North America behind Cedars-Sinai Medical Center in Los Angeles.

"The first post FDA-approval sternotomy HVAD implant in the U.S. was done at Vanderbilt," Danter said. "The first post-approval thoracotomy implant of an HVAD was just done at Vanderbilt with Mr. Thorpe. We continue to be a proponent of advancing these techniques forward, and this speaks to the breadth and depth of the heart failure program here at Vanderbilt.

"With the extremely dedicated group of surgeons, heart failure cardiologists, nurses and intensive care doctors, Vanderbilt will continue to be a leader nationally in the management of patients with advanced heart failure."

Thorpe, a retired custodial supervisor for a school district, said his health got so bad he had to stop working and then it just kept getting worse.

He's looking forward to being able to do simple activities again, like mowing his lawn and cutting his hedge. But his wife, Rose Thorpe, said she wants him in the kitchen first. She's been missing his chicken and dressing.

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