Chetan Pasrija1, Mariem A Sawan2, Erik Sorensen3, Hannah Voorhees3, Aakash Shah1, Erik Strauss4, Van-Khue Ton2, Laura DiChiacchio1, David J Kaczorowski1, Bartley P Griffith1, Si M Pham5, Zachary N Kon6. 1. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA. 2. Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. 3. Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA. 4. Department of Anaesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA. 5. Department of Cardiothoracic Surgery, Mayo Medical Center, Jacksonville, FL, USA. 6. Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.
Abstract
OBJECTIVES: Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation continues to be a morbid complication. In this study, we hypothesized that a less invasive approach to implantation would preserve RV function relative to a conventional sternotomy (CS) approach. METHODS: All patients (2013-2017) who underwent LVAD implantation were reviewed. Patients were stratified by surgical approach: less invasive left thoracotomy with hemi-sternotomy (LTHS) and CS. The primary outcome was severe RV failure. RESULTS: Eighty-three patients (LTHS: 37, CS: 46) were identified. The median Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score was significantly worse in the LTHS compared to the CS 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. Though operative time did not significantly differ between the 2 groups, cardiopulmonary bypass time was significantly shorter in the LTHS group (61 vs 95 min, P < 0.001). 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 (3% vs 26%, P = 0.005). Improvement in RV function, along with a change in pulmonary artery pulsatility index, was significantly greater in the LTHS cohort. There was a trend towards improved Kaplan-Meier 1-year survival in the LTHS cohort (91% vs 56%, P = 0.056). CONCLUSIONS: In this cohort, less invasive LVAD implantation appears to be associated with reduced postoperative RV failure, and equivalent or improved survival compared to conventional LVAD implantation.
OBJECTIVES: Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation continues to be a morbid complication. In this study, we hypothesized that a less invasive approach to implantation would preserve RV function relative to a conventional sternotomy (CS) approach. METHODS: All patients (2013-2017) who underwent LVAD implantation were reviewed. Patients were stratified by surgical approach: less invasive left thoracotomy with hemi-sternotomy (LTHS) and CS. The primary outcome was severe RV failure. RESULTS: Eighty-three patients (LTHS: 37, CS: 46) were identified. The median Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score was significantly worse in the LTHS compared to the CS 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. Though operative time did not significantly differ between the 2 groups, cardiopulmonary bypass time was significantly shorter in the LTHS group (61 vs 95 min, P < 0.001). 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 (3% vs 26%, P = 0.005). Improvement in RV function, along with a change in pulmonary artery pulsatility index, was significantly greater in the LTHS cohort. There was a trend towards improved Kaplan-Meier 1-year survival in the LTHS cohort (91% vs 56%, P = 0.056). CONCLUSIONS: In this cohort, less invasive LVAD implantation appears to be associated with reduced postoperative RV failure, and equivalent or improved survival compared to conventional LVAD implantation.
Keywords:
Less invasive left ventricular assist device implantation; Minimally invasive ventricular assist device implantation; Postoperative right ventricular failure; Right ventricular failure after left ventricular assist device implantation
Authors: Silvia Mariani; Tong Li; Karl Bounader; Dietmar Boethig; Alexandra Schöde; Jasmin S Hanke; Jana Michaelis; L Christian Napp; Dominik Berliner; Guenes Dogan; Roberto Lorusso; Axel Haverich; Jan D Schmitto Journal: Ann Cardiothorac Surg Date: 2021-03
Authors: Thomas Schlöglhofer; Franziska Wittmann; Robert Paus; Julia Riebandt; Anne-Kristin Schaefer; Philipp Angleitner; Marcus Granegger; Philipp Aigner; Dominik Wiedemann; Günther Laufer; Heinrich Schima; Daniel Zimpfer Journal: Life (Basel) Date: 2022-03-20