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Less invasive left ventricular assist device implantation may reduce right ventricular failure.

Abstract

OBJECTIVES

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.

Authors+Show Affiliations

Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA.Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA.Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.Department of Anaesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.Department of Cardiothoracic Surgery, Mayo Medical Center, Jacksonville, FL, USA.Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31326991

Citation

Pasrija, Chetan, et al. "Less Invasive Left Ventricular Assist Device Implantation May Reduce Right Ventricular Failure." Interactive Cardiovascular and Thoracic Surgery, 2019.
Pasrija C, Sawan MA, Sorensen E, et al. Less invasive left ventricular assist device implantation may reduce right ventricular failure. Interact Cardiovasc Thorac Surg. 2019.
Pasrija, C., Sawan, M. A., Sorensen, E., Voorhees, H., Shah, A., Strauss, E., ... Kon, Z. N. (2019). Less invasive left ventricular assist device implantation may reduce right ventricular failure. Interactive Cardiovascular and Thoracic Surgery, doi:10.1093/icvts/ivz143.
Pasrija C, et al. Less Invasive Left Ventricular Assist Device Implantation May Reduce Right Ventricular Failure. Interact Cardiovasc Thorac Surg. 2019 Jul 21; PubMed PMID: 31326991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Less invasive left ventricular assist device implantation may reduce right ventricular failure. AU - Pasrija,Chetan, AU - Sawan,Mariem A, AU - Sorensen,Erik, AU - Voorhees,Hannah, AU - Shah,Aakash, AU - Strauss,Erik, AU - Ton,Van-Khue, AU - DiChiacchio,Laura, AU - Kaczorowski,David J, AU - Griffith,Bartley P, AU - Pham,Si M, AU - Kon,Zachary N, Y1 - 2019/07/21/ PY - 2018/11/14/received PY - 2019/05/08/revised PY - 2019/05/13/accepted PY - 2019/7/22/entrez PY - 2019/7/22/pubmed PY - 2019/7/22/medline KW - Less invasive left ventricular assist device implantation KW - Minimally invasive ventricular assist device implantation KW - Postoperative right ventricular failure KW - Right ventricular failure after left ventricular assist device implantation JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg N2 - OBJECTIVES: 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. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/31326991/Less_invasive_left_ventricular_assist_device_implantation_may_reduce_right_ventricular_failure L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivz143 DB - PRIME DP - Unbound Medicine ER -