Multicenter Study to Evaluate Less Invasive Ventricular Assist Device Implantation in Patients with History of Previous Cardiac Surgeries

Background: Several studies have been published showing advantages of less invasive LVAD implantation (LIS) approach compared with conventional sternotomy (CS) approach. The aim of this multicenter study was to investigate the outcome of LIS approach with special focus on patients with history of prior cardiac surgeries.

Method: All patients who received an LVAD implantation in the two centers between January 2015 and May 2022 were analyzed retrospectively. Inclusion criteria were patients with history of previous cardiac procedures. Patients with concomitant procedures at the time of LVAD implantation were excluded. A propensity score method was used to create two identical groups in a 1:1 fashion.

Results: A total of 158 patients met the inclusion criteria. Twenty-four patients were excluded from the CS group due to concomitant procedures at the time of LVAD implantation. The remaining unmatched cohort included 69 patients in the CS group, and 65 patients in the LIS group. The groups were not identical with higher mean age in the LIS group (60 vs. 65 years old, p ≤ 0.001) and higher rate of ECLS support in the CS approach (23 vs. 9.2%, p = 0.029). A propensity matching analysis produced two similar groups each including 52 patients. In the matched groups, the number of intraoperative use of PRBC units was higher in the CS group (4.0 [2.0, 5.0] vs. 0.0 [0.0, 3.0]); p ≤ 0. 001. Furthermore, total amount of blood loss during the first 24 hours was significantly higher in the CS group (1.9 vs. 1.1 L; p = 0.043). However, reexploration rate for major bleeding was necessary in 22% in the CS group versus 16% in the LIS group (p = 0.4). There was no significant difference in the ICU or LOS stay at the time of follow-up (PI: 0.5; PI: 0.12). However, the rate of patients who needed postoperatively renal dialysis or RVAD support was significantly higher in the CS group 57 vs. 24% (p < 0.001) and 23 vs. 3.8% (p = 0.004), respectively. In the CS group, the surgery time was shorter (215 vs. 280 min; p < 0.001). The 1-year survival was, in matched groups, significantly higher in the LIS group (69 vs. 50%; p = 0.044).

Conclusion: The LIS approach for LVAD implantation in patients with history of previous cardiac procedures is associated with lower rate of blood product utilization, renal dialysis, RV failure and RVAD use, and better survival rate at the payoff of longer duration of the surgery.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023