Less Invasive LVAD Implantation Decreases Postoperative Right Ventricular Dysfunction

Abstract

<h3>Purpose</h3> Right ventricular failure (RVF) remains one of the major cause of morbidity and mortality after left ventricular assist device (LVAD) surgery. The purpose of this study was to investigate the incidence of RVF after less invasive surgery (LIS) LVAD surgery compared to median sternotomy. <h3>Methods</h3> The study population comprised of 231 patients who underwent HeartMate 3 LVAD implantation in our institution between September 2015 and June 2020. Patients were compared based on surgical approach: full sternotomy (FS) or LIS. The primary outcome was RVF as defined by INTERMACS. Index hospitalization major complications and survival were secondary outcomes. <h3>Results</h3> LIS approach was used in 161 (69.7%) patients and FS approach in 70 (30.3%) of our LVAD patients. Baseline patient characteristics were similar between cohorts apart from LIS patients being younger (54±14 vs 60±11, p=0.003). Postoperatively, LIS patients had decreased postoperative bleeding (p=0.001) and shorter time on mechanical ventilation (p<0.001) or inotropes (p=0.0042). LIS was associated with a 3-fold reduction in the primary endpoint of RVF (8.7% vs 28.6%; respectively; p<0.001) as well as in the need for Right Ventricular Assist Device support (5 vs 17.1%, p=0.003). Multivariate analysis showed that LIS was associated with a significant reduction in the risk of major postoperative events (Figure 1), including a 76% (p<0.001) reduction in RVF occurrence and a 75% (p=0.004) reduction in the need for RVAD support. Survival at index hospitalization was higher with LIS vs. FS (91.3% vs 78.6%, p=0.0073). <h3>Conclusion</h3> Less invasive LVAD implantation is associated with improved perioperative outcomes compared to median sternotomy, including a lower incidence of severe right heart failure and need for temporary mechanical circulatory support. Further research is needed to elucidate the mechanism of the less invasive approach in preserving RV function.