Reduced Rethoracotomy Rate for Bleeding and Postoperative Hospital Stay with Less Invasive Ventricular Assist Device Implantation, Multicenter Experience

Abstract

Available studies comparing sternotomy to less invasive (LIS) approach for left ventricular assist device (LVAD) Implantation are limited to few patients. The aim of this study was compare the outcome between these two surgical approaches. Data of two high volume VAD centers were collected. Inclusion criteria were patients supported with LVAD between 01.2014 and 12.2018 using less invasive (LIS) or full sternotomy approach. The LIS and Sternotomy approaches were compared for preoperative characteristics and postoperative outcome. Out of 342 implanted VADs during this period, LIS approach was used in 101 patients (30%). The preoperative characteristics from both groups were identical except for more patients on VA-ECMO (24 % vs 10%, p=0.003), lower INTERMACS profile (p<0.001) and more redo surgeries (p=0.06) in sternotomy patients. Propensity score matching (1:1) was performed to match for these parameters and resulted in 100 patients remaining in each group. Following matching, postoperative mild and moderate RV failure rates were comparable. However, higher rate of severe RVF was documented in sternotomy Group (27% vs. 11% p= 0.02). Meanwhile, the rate of RVAD placement was comparable (p=0.2). Moreover, higher rate of postoperative reexploration for bleeding was seen in sternotomy group (18% vs. 4 %, p= 0.001). Further, the duration of hospital stay was significantly longer in sternotomy group (34 days (25-57) vs. 27 days (22-42) in LIS group, p=0.009). Stroke, pump thrombosis, GI bleeding, and driveline infection rates were comparable. The short and long term survival remains comparable between the matched groups (p= 0.93) (Figure 1). In this matched group of patients, LIS approach seems to result in lower postoperative morbidities (lower reexploration rate for bleeding and severe RV failure) and shorter hospital stay. Nevertheless, the survival remains similar between the groups.