The Effect of Left Thoracotomy LVAD Implantation to LVAD Surgery and Followed Heart Transplantation Surgery

Abstract

Left ventricular assist device (LVAD) implantations have traditionally been approached via full median sternotomy (FS). Recently, minimally invasive left thoracotomy (LT) approach has been popularized with improved surgical technique and emergence of smaller centrifugal LVAD devices. However, the surgical outcomes from minimal surgical approach remains to be unclear. The primary objective was to compare outcomes among patients who received an LVAD via FS compared to LT as well as their subsequent outcomes following heart transplantation. This is a single center retrospective study. 126 patients who underwent primary LVAD implantation from Jan 2014 to June 2018 are included (FS group n=83, LT group n=43). 49 patients had following HT (FS group n=27, LT group n=22). Preoperative patient demographics, intraoperative variables, hospital stay, postoperative survival and complications from LVAD implantation and heart transplantation were analyzed. Preoperatively, FS group had higher right atrial pressure (p<0.05). Intraoperative data showed LT group had 24% longer LVAD implant surgical time (p<0.05). Kaplan Meier curve showed better survival in LT group after LVAD implantation (p=0.04). The 1 year survival rate after heart transplantation was 100% for both groups. For post LVAD complications, FS group had more gastrointestinal bleeding events (p<0.05). There were no significant differences in post heart transplantation complications. Lastly, average length of hospital stay after LVAD implantation and heart transplantation showed no significance, respectively (25.0±24.9 vs 19.3±12.0, p=0.18),(28.2±41.9 vs 21.1± 13.7, p=0.46). Our study showed LT group was associated with improved survival after LVAD implantation. However, our study has limitation of containing bias from retrospective, non-randomized study design. Further, larger studies are warranted to prove the effects of minimally invasive LVAD implantation surgery.