Perioperative Hemodynamics And Right Ventricular Performance During Lvad Implantation Via Median Sternotomy V. Lateral Thoracotomy.

Abstract

Background : Perioperative right ventricular dysfunction (RVD) is common during implantation of a left ventricular assist device (LVAD). While an LVAD may be implanted via median sternotomy (MS) or lateral thoracotomy (LT), data comparing hemodynamics during these surgical approaches are sparse. Methods : Twenty-one patients with advanced heart failure were randomized in a 1:1 fashion to undergo LVAD implantation via MS v. LT. Cardiovascular hemodynamics and RV function were simultaneously measured via Swan-Ganz catheterization and conductance catheters for real-time RV pressure-volume (PV) analysis. Data were collected at three timepoints: 1) Baseline immediately before surgery; 2) Postoperative Day 0 in the intensive care unit (ICU); and 3) Postoperative Day 1 in the ICU. Results : Baseline characteristics are displayed in Table 1. LVAD was implanted via MS v. LT in ten v. eleven patients, respectively. Sixteen patients received a Heartware VAD and five received a Heartmate 3 LVAD. Right atrial and mean pulmonary arterial pressures declined over time for patients undergoing LVAD implantation via LT but increased in response to MS (Figure 1). RV stroke volume and cardiac output were higher on postoperative day 1 among LT v. MS patients (Figure 1, Table 2). Other metrics of RV performance, determined by RV PV analysis, were similar between groups (Table 2). Conclusion : In this pilot analysis, LVAD implantation via LT may be associated with more favorable perioperative cardiovascular hemodynamics and RV contractility than MS. Further analysis is necessary to determine differences in longterm outcomes. : Perioperative right ventricular dysfunction (RVD) is common during implantation of a left ventricular assist device (LVAD). While an LVAD may be implanted via median sternotomy (MS) or lateral thoracotomy (LT), data comparing hemodynamics during these surgical approaches are sparse. : Twenty-one patients with advanced heart failure were randomized in a 1:1 fashion to undergo LVAD implantation via MS v. LT. Cardiovascular hemodynamics and RV function were simultaneously measured via Swan-Ganz catheterization and conductance catheters for real-time RV pressure-volume (PV) analysis. Data were collected at three timepoints: 1) Baseline immediately before surgery; 2) Postoperative Day 0 in the intensive care unit (ICU); and 3) Postoperative Day 1 in the ICU. : Baseline characteristics are displayed in Table 1. LVAD was implanted via MS v. LT in ten v. eleven patients, respectively. Sixteen patients received a Heartware VAD and five received a Heartmate 3 LVAD. Right atrial and mean pulmonary arterial pressures declined over time for patients undergoing LVAD implantation via LT but increased in response to MS (Figure 1). RV stroke volume and cardiac output were higher on postoperative day 1 among LT v. MS patients (Figure 1, Table 2). Other metrics of RV performance, determined by RV PV analysis, were similar between groups (Table 2). : In this pilot analysis, LVAD implantation via LT may be associated with more favorable perioperative cardiovascular hemodynamics and RV contractility than MS. Further analysis is necessary to determine differences in longterm outcomes.