Less Is Better? Comparing Effects of Median Sternotomy and Thoracotomy Surgical Approaches for LVAD Implantation on Post-Operative Outcomes and Valvulopathy

Structured AbstracT

Objective

Our objective was to compare outcomes following left ventricular assist device (LVAD) implantation performed via median sternotomy (MS) or lateral thoracotomy (LT).

Methods

We retrospectively analyzed 222 adult patients implanted with the HeartMate 3 (HM3) LVAD between November 2014 and November 2021. Outcomes stratified by surgical approach were evaluated in propensity score-matched (PSM) groups. The primary outcome was 1-year survival. Secondary outcomes included in-hospital morbidity and mortality, readmissions, and significant valvular regurgitation.

Results

Our cohort consisted of 60 (27%) LT and 162 (73%) MS patients. PSM compared 45 LT to 68 MS patients—there were no differences in ICU or hospital stay duration (median, 10 vs. 11 days, P = 0.58; 46 vs. 40 days, P = 0.279), time to extubation (median, 2 days, P = 0.627), VIS at ICU arrival (18.20 vs. 16.60, P = 0.654), or in-hospital mortality (2 (5%) vs. 4 (6.1%) patients, P = 1). 1-year survival (95.56% vs. 90.61%, P = 0.48) and all-cause hospital readmission rates (Gray's test: P = 0.532) were also comparable. LT patients had significantly less early right ventricular failure (24.4% vs. 53.7%, P = 0.004), though more follow-up tricuspid regurgitation (17.6% vs. 0%, P = 0.030) and volume overload readmissions (Gray's test: P = 0.0005).

Conclusion

Our data suggest that LT is a safe though not necessarily superior alternative to MS for HM3 implantation in the peri- and postoperative periods, as it precludes concomitant tricuspid valve repairs and may be associated with increased risk of late tricuspid regurgitation and volume overload readmissions.