BACKGROUND: Conventional median sternotomy (CMS) is still the standard technique utilized to implant left ventricular assist devices (LVADs). Recent studies suggest that less invasive surgery (LIS) may be beneficial; however, robust data on differences in right heart failure (RHF) are lacking. This study aimed to determine the impact of LIS compared with that of CMS on RHF outcomes after LVAD implantation. METHODS: An international multicenter retrospective cohort study was conducted across 5 centers. Patients were grouped according to their implantation technique (LIS vs CMS). Only centrifugal devices were included. RHF was defined as severe or severe acute RHF according to the 2013 Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definition. Logistic multivariate regression and propensity score‒matched analyses were performed to account for confounding. RESULTS: Overall, 427 implantations occurred during the study period, with 305 patients implanted using CMS and 122 using LIS. Pre-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) use was more common in the CMS group; off-pump implantation was more common in the LIS group. Other pre-implant variables, including age, creatinine, hemodynamics, and tricuspid regurgitation, did not differ between the 2 groups. Post-operative RHF was less common in the patients who underwent LIS than in those who underwent CMS as was post-operative right ventricular assist device (RVAD) use. LIS remained associated with less RHF in the multivariate analysis. After propensity score matching conditional for age, sex, INTERMACS profile, ECMO, and IABP use in a ratio of 2:1 (CMS to LIS), RHF (29.9% vs 18.6%, p = 0.001) and the need for post-operative RVAD (18.6% vs 8.2%; p = 0.009) remained more common in the CMS group than in the LIS group. There were no significant differences in survival up to 1 year between the groups. CONCLUSIONS: LIS may be associated with less RHF after LVAD implantation compared with CMS. Despite the possible reduction in RHF, there was no difference in 1-year survival. LIS is an alternative to traditional CMS.
Bibliographical noteFunding Information:
R.C. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include serving on a speaker's bureau for Abbott and on the heart failure advisory board for Medtronic. Her spouse is employed by Medtronic. R.J. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include serving as a consultant to Medtronic and Abbott. L.L. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include an intellectual property with Abbott. B.A.H. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include receiving research funding from Medtronic for work outside this study. R.J.T. reports no direct conflicts relevant to this manuscript. Other general conflicts include consulting relationships with Medtronic, Aria CV Inc., Arena Pharmaceuticals, Acceleron, Eidos Therapeutics, Gradient, and United Therapeutics. R.J.T. is on a steering committee for Medtronic and Abbott as well as a research advisory board for Abiomed. He also does hemodynamic core laboratory work for Actelion and Merck. The remaining authors have no conflicts of interest to disclose.
© 2021 International Society for Heart and Lung Transplantation
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- mechanical circulatory support
- pulmonary hypertension
- right heart failure
- right ventricle