Subcostal LVAD Exchange Is Associated with Shorter Recovery and Improved Long Term Survival Than Full Sternotomy Approach

Abstract

Purpose Although the quality and durability of left ventricular assist device (LVAD) have been improved recently, device failure remains to be a serious issue with increased waiting time for bridge to transplant and improved survival in destination therapy. LVAD exchange can be done by full sternotomy for a radical revision or by a less-invasive subcostal approach. Either results of LVAD exchange or surgical techniques, however, are not well investigated. Methods and Materials Among 176 consecutive patients who had LVAD implantation between January 2008 and June 2012, total 16 patients underwent 17 pump exchanges. Eight had subcostal (SC group, n=8) approach and the rest had full sternotomy (FS group, n=9). Mortality, hospital stay, operation time, cardiopulmonary bypass time and amount of perioperative blood transfusion were analyzed. All data were prospectively collected for STS and institutional databases. Results Total 13 HeartMate II, 2 HVAD and 2 VentraAssist were used for pump exchange. Fourteen had pump failure due to thrombus and 3 had driveline failure. Post-operative 30-day mortality was 25% (3 FS, 1 SC) and 1-year mortality was 50% (5 FS, 3 SC) in the entire group. One year mortality in the SC group was significantly lower (33% vs. 63%, p Conclusions LVAD failure remains a devastating complication. Any pump exchange resulted in high mortality both in short and mid-term. SC approach provides a decreased OR time and a shorter recovery as well as improved one-year survival compared to the FS group. A better pre-operative optimization, earlier and less invasive surgical approach may help us achieve a better result in LVAD exchange.