Exploring the Benefit of Thoracotomy LVAD Implant on Subsequent Sternal Entry for Heart Transplantation

Abstract

<h3>Purpose</h3> Minimally invasive left ventricular assist device (LVAD) implantation via left thoracotomy has previously been shown to be a safe operation with potential advantages compared to sternotomy. These advantages include improved inflow cannula positioning as well as minimising adhesions for subsequent sternal entry for heart transplantation. We wanted to assess the impact of LVAD implant technique on subsequent heart transplantation. <h3>Methods</h3> All patients who received an LVAD via thoracotomy and subsequently transplanted were included. This group was matched 2:1 with patients who received an LVAD via sternotomy and were subsequently transplanted. Patients in the sternotomy group were excluded if they had a prior sternotomy to LVAD insertion. Parameters such as cardiopulmonary bypass time, blood usage, post-operative length of stay, morbidity and mortality measures were extracted. <h3>Results</h3> 12 Thoracotomy patients and 24 sternotomy patients were included in the study. There was no significant difference in gender, BMI or age between the two groups. When assessing operation variables, there was no significant difference in operation duration, cardiopulmonary bypass time or cross clamp time between the sternotomy and thoracotomy groups. Similarly, there was no significant difference in blood product administration (red blood cells, cryoprecipitate, fresh frozen plasma, platelets) intraoperatively. There was no difference in total length of stay, ICU length of stay, ventilation time and 30-day mortality. <h3>Conclusion</h3> In our sample size of 36 patients, we could not demonstrate a significant difference in peri-operative variables between VAD patients who presented for their heart transplant subsequent to receiving an LVAD implanted via either sternotomy or thoracotomy. These findings suggest that while thoracotomy for LVAD insertion may present advantages such as improved inflow cannula positioning, we could not demonstrate a clear benefit in sternal entry for subsequent transplant.