Impact of Surgical Approach on Outcome in Patients with History of Previous Sternotomy Underwent LVAD Implantation

Abstract

<h3>Purpose</h3> The purpose of this study is to investigate the impact of the surgical approach on the outcome of patients with previous history of sternotomy. <h3>Methods</h3> Between January 2015 und September 2021, a total of 73 patients with a previous history of sternotomy received LVAD Implantation through two different approaches (less invasive and full sternotomy). The J-Sternotomy and anterolateral thoracotomy was used in all LIS patients. Data collection included baseline demographics, hemodynamic and implant data, adverse events and survival. The outcomes of the LIS and Sternotomy approaches were compared. <h3>Results</h3> Our cohort included 73 patients who underwent LVAD implantation. A total of 60 patients were operated using the old sternotomy approach, the remaining patients underwent LVAD-implantation through a LIS approach. Reexploration rate for bleeding was necessary in 25 % (15/60) in the full sternotomy group compared with 8.3 % (1/12) the less-invasive surgery group. Intensive care unit (ICU) stay for the LIS group was lower than for the sternotomy group (17.3 days vs. 18.2 days). The LIS group had less postoperative blood transfusion. The median operative time was also lower in the LIS group compared to the FS group (85 min vs. 96 min). Finally, the LIS group showed a lower rate of severe right heart failure with the need of right ventricular assist device (RVAD) Implantation (8.3 % vs. 18.3%). <h3>Conclusion</h3> The less-invasive surgery approach is a safe technique for left ventricular assist device implantation also in patients with history of previous sternotomy. Less-invasive surgery was associated with a reduction in the postoperative bleeding complications, duration of ICU stay, and RVAD implantation.