Less invasive left ventricular assist device implantation may reduce right ventricular failure

Chetan Pasrija; Mariem A Sawan; Erik Sorensen; Hannah Voorhees; Aakash Shah; Erik Strauss; Van-Khue Ton; Laura DiChiacchio; David J Kaczorowski; Bartley P Griffith; Si M Pham; Zachary N Kon

doi:10.1093/icvts/ivz143

Less invasive left ventricular assist device implantation may reduce right ventricular failure

Interact Cardiovasc Thorac Surg. 2019 Oct 1;29(4):592-598. doi: 10.1093/icvts/ivz143.

Authors

Affiliations

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.

PMID: 31326991
DOI: 10.1093/icvts/ivz143

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.

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.

MeSH terms

Adult
Cohort Studies
Female
Heart Failure / physiopathology
Heart Failure / therapy*
Heart-Assist Devices*
Humans
Incidence
Male
Middle Aged
Pulmonary Artery / surgery
Registries
Retrospective Studies
Sternotomy / adverse effects*
Thoracotomy / adverse effects*
Ventricular Dysfunction, Right / epidemiology
Ventricular Dysfunction, Right / physiopathology
Ventricular Dysfunction, Right / prevention & control*
Ventricular Function, Right