Minimal-Access Left Ventricular Assist Device Implantation
Bibliographic record
Abstract
OBJECTIVE: The left ventricular assist device (LVAD) is typically implanted through a full sternotomy on cardiopulmonary bypass (CPB). Minimally invasive surgery (MIS) modifications include multiple smaller incisions, using "virgin" territory, and minimized CPB time. METHODS: Forty-two LVAD implantations were retrospectively reviewed. Twenty-five minimally invasive implantations (MIS, 20 HeartMate II and 5 HeartWare) were compared with 17 sternotomy implantations (12 HeartMate II and 5 HeartWare). The choice of MIS incisions was device dependent: (1) three separate incisions for the HeartMate II or (2) two incisions for the HeartWare device. Four HeartWare LVADs were implanted off-pump (three using the MIS approach). RESULTS: The median patient age was 52 years (range, 18-69 years). Overall survival was 81% at a mean (SD) follow-up of 495 (375) days. Thirty-day mortality was 9.5% (one MIS and three sternotomy patients). Five patients (11.9%) died while on LVAD, 18 (42.9%) underwent transplantation, 6 (14.3%) underwent weaning and explantation, and 13 (31.0%) remained on support. Preoperative ventilatory and circulatory supports were more common in the sternotomy group. The MIS patients had shorter CPB time [51.4 (34.9) vs 83.6 (40.4) minutes, P = 0.014] and showed a trend toward lower red blood cell and platelet transfusion requirement. The durations of hospitalization, inotropic support, intensive care unit stay, and LVAD support were not significantly different. CONCLUSIONS: Minimally invasive surgery LVAD implantation is feasible. The shorter CPB duration and off-pump approach may be advantageous. Avoiding sternotomy may also reduce adhesions encountered during subsequent cardiac transplantation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".