Outcome Of Less Invasive Left Ventricular Assist Device Implantation Through Left Thoracotomy With Mini-sternotomy
Sanjay Kumar1, Vladimir Shumaster2.
1Institute of Medical Sciences, Varanasi, India, 2Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.
OBJECTIVES: The morbidity and mortality associated with Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation continues to be a major complication. In this study, we studied the hypothesis that a less invasive approach to implantation would preserve RV function and mortality relative to a conventional full sternotomy (CFS) approach. METHODS: We reviewed all consecutive patients who underwent LVAD implantation between January 2012 and December 2018. The primary outcome studied was severe RV failure and associated morbidity and mortality. Patients were divided into two groups as per surgical approach: less invasive left thoracotomy with mini-sternotomy (LTMS) and CFS. RESULTS: We studied 76 patients (LTMS: 31, CFS: 45) were identified. The median INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support) score was significantly worse in the LTMS compared to the CFS cohort, and there was a trend towards higher RV failure scores and HeartMate II mortality scores. Preoperative RV dysfunction, in pulmonary artery pulsatility index and RV stroke work index were similar between the 2 groups. The cardiopulmonary bypass time was significantly shorter in the LTHS group (61 vs 95 min, P < 0.001). The operative time did not significantly differ between the two groups. Improvement in RV function, along with a change in pulmonary artery pulsatility index, was significantly greater in the LTHS cohort. The incidence of postoperative severe RV failure was significantly reduced in the LTHS group (16% vs 39%, P = 0.030), along with the need for temporary right ventricular assist device (5% vs 29%, P = 0.005). There was a trend towards improved survival Kaplan-Meier 1-year survival in the LTHS cohort (89% vs 52%, P = 0.056). CONCLUSIONS: In this cohort, minimal access LVAD implantation appears to be associated with reduced postoperative RV-failure, and improved survival compared to conventional LVAD implantation.
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