Stroke and Pump Thrombosis Following LVAD Implantation: The Impact of the Implantation Approach

Abstract

<h3>Purpose</h3> The aim of this study is to investigate the impact of LVAD (left ventricular assist device) implantation technique on long-term mortality and morbidity, with special focus on stroke and pump thrombosis. <h3>Methods</h3> A retrospective data analysis was performed between 01/2015 and 03/2021 to identify patients who underwent LVAD implantation using either standard sternotomy (ST) approach or less invasive (LIS) approach. The LIS implantation was performed using a partial J-shaped sternotomy and left anterior mini-thoracotomy. All patients were followed up until 08/2021. Postoperative complications were collected according to INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) definitions, including severe RVF (right ventricle failure). The propensity score method was used to create 2 groups. Primary outcome was survival to discharge and during follow-up. Secondary outcomes were incidence of stroke and pump thrombosis during follow-up. <h3>Results</h3> The unmatched cohort included total 335 patients. Sternotomy was used in 242 (72.2%) patients and LIS in 93 (27.8%). Propensity matching produced 2 groups: 98 patients in ST and 67 in LIS. In the matched groups median follow-up was 612 days (IQR, 160-1172) in ST group compared with 463 days (IQR, 204-943) in LIS group (P= .4). In the matched cohort intensive care unit stay for LIS group was significantly lower than for the ST group (2, [IQR, 2-5] days vs 4, [IQR, 2-12] days; P< .01). Hospital mortality was significantly lower in the LIS group 7.5% (5/67) vs 18% (18/98) (P< .05). However, overall mortality, in the matched cohort, did not differ between the groups (ST, n=43 vs LIS, n=23; P=.2). The rate of stroke showed no significant difference in the matched cohort (n=10 ST vs n=9 LIS; P=.6). The pump thrombosis did not differ between groups in the matched cohort (n=6 ST vs n=5 LIS; P=.8). The reexploration rate for bleeding was necessary in 18% (18/98) in the ST group compared with 9% (6/67) in LIS group (P= .09). Severe RVF required temporary RVAD implantation occurred less often in the LIS group (10%, 7/67) in compare to ST group (19%, 19/98); P=.12. <h3>Conclusion</h3> LIS approach for LVAD implantation is a safe procedure with potential advantage in the early postoperative period. Postoperative stroke and pump thrombosis seems to be comparable for both surgical approach.