Objectives: Avoiding full sternotomy may reduce the invasiveness of left ventricular assist device
(LVAD) implantation. Studies comparing sternotomy to less-invasive (LIS) approach
is limited to anecdotal case reports or only few patients. The aim of this study was
to compare the outcome between these two surgical approaches.
Methods: Data of two high volume VAD centers were collected and analyzed. Inclusion criteria
were patients supported with LVAD between January 2014 and December 2018 using less
invasive (LIS) or full sternotomy approach. The LIS and Sternotomy approaches were
compared for preoperative characteristics/hemodynamic profile and postoperative hemodynamic
profile, ICU/hospital stay, adverse event rates, and overall survival.
Results: Out of 342 implanted VADs during this period, LIS approach was used in 101 patients
(30%). The LIS approach was feasible in all patients with no need for conversion.
The preoperative characteristics from both groups were identical except for more patients
on venoarterial extra corporeal membrane oxygenation (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 was performed to match
for these parameters and resulted in 100 patients remaining in each group and were
compared. Mild and moderate RV failure rates were comparable. However, higher rate
of severe RVF in sternotomy group was documented (27 vs. 11% p = 0.02). Meanwhile, the acute severe RVF requiring right ventricular assist device
was comparable (15% in sternotomy vs. 8% in LIS group, p = 0.2). Stroke, pump thrombosis, GI bleeding, and driveline infection rates were
comparable between both groups (p = 0.3, 0.9, 0.4, and 0.5, respectively). The duration of intensive care unit was
comparable (p = 0.2). 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). The short and long-term survival remains comparable between the groups
(p = 0.93).
Conclusion: 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.
