Less invasive left ventricular assist device implantation may reduce right ventricular failure
JournalInteractive cardiovascular and thoracic surgery
PublisherOxford University Press
MetadataShow full item record
AbstractOBJECTIVES: Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation continues to be a morbid complication. In this study, we hypothesized that a less invasive approach to implantation would preserve RV function relative to a conventional sternotomy (CS) approach. METHODS: All patients (2013–2017) who underwent LVAD implantation were reviewed. Patients were stratified by surgical approach: less invasive left thoracotomy with hemi-sternotomy (LTHS) and CS. The primary outcome was severe RV failure. RESULTS: Eighty-three patients (LTHS: 37, CS: 46) were identified. The median Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score was significantly worse in the LTHS compared to the CS cohort, and there was a trend towards higher RV failure scores and HeartMate II mortality scores. Preoperative RV dysfunction, in pulmonary artery pulsatility index and RV stroke work index were similar between the 2 groups. Though operative time did not significantly differ between the 2 groups, cardiopulmonary bypass time was significantly shorter in the LTHS group (61 vs 95 min, P < 0.001). The incidence of postoperative severe RV failure was significantly reduced in the LTHS group (16% vs 39%, P = 0.030), along with the need for temporary right ventricular assist device (3% vs 26%, P = 0.005). Improvement in RV function, along with a change in pulmonary artery pulsatility index, was significantly greater in the LTHS cohort. There was a trend towards improved Kaplan–Meier 1-year survival in the LTHS cohort (91% vs 56%, P = 0.056). CONCLUSIONS: In this cohort, less invasive LVAD implantation appears to be associated with reduced postoperative RV failure, and equivalent or improved survival compared to conventional LVAD implantation. Copyright The Author(s) 2019.
KeywordLess invasive left ventricular assist device implantation
Minimally invasive ventricular assist device implantation
Postoperative right ventricular failure
Right ventricular failure after left ventricular assist device implantation
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85072687417&doi=10.1093%2ficvts%2fivz143&partnerID=40&md5=c3de9ebea293d6a8064fa37c58594745; http://hdl.handle.net/10713/11042
- Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients.
- Authors: Pasrija C, Sawan MA, Sorensen E, Voorhees HJ, Shah A, Wang L, Ton VK, DiChiacchio L, Kaczorowski DJ, Griffith BP, Pham SM, Kon ZN
- Issue date: 2020 May/Jun
- Temporary right ventricular support following left ventricle assist device implantation: a comparison of two techniques.
- Authors: Noly PE, Kirsch M, Quessard A, Leger P, Pavie A, Amour J, Leprince P
- Issue date: 2014 Jul
- Significance of Residual Mitral Regurgitation After Continuous Flow Left Ventricular Assist Device Implantation.
- Authors: Kassis H, Cherukuri K, Agarwal R, Kanwar M, Elapavaluru S, Sokos GG, Moraca RJ, Bailey SH, Murali S, Benza RL, Raina A
- Issue date: 2017 Feb
- Right ventricular function and residual mitral regurgitation after left ventricular assist device implantation determines the incidence of right heart failure.
- Authors: Tang PC, Haft JW, Romano MA, Bitar A, Hasan R, Palardy M, Wu X, Aaronson KD, Pagani FD
- Issue date: 2020 Mar
- Pulmonary artery pulsatility index predicts prolonged inotrope/pulmonary vasodilator use after implantation of continuous flow left ventricular assist device.
- Authors: Aggarwal V, Tume SC, Rodriguez M, Adachi I, Cabrera AG, Tunuguntla H, Qureshi AM
- Issue date: 2019 Nov
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