Leipzig Heart Center, Leipzig, Germany; Düsseldorf University Hospital, Düsseldorf, Germany.
Erasmus MC, Rotterdam, The Netherlands.
J Heart Lung Transplant. 2021 Apr;40(4):289-297. doi: 10.1016/j.healun.2021.01.005. Epub 2021 Jan 12.
Conventional median sternotomy (CMS) is still the standard technique utilized to implant left ventricular assist devices (LVADs). Recent studies suggest that less invasive surgery (LIS) may be beneficial; however, robust data on differences in right heart failure (RHF) are lacking. This study aimed to determine the impact of LIS compared with that of CMS on RHF outcomes after LVAD implantation.
An international multicenter retrospective cohort study was conducted across 5 centers. Patients were grouped according to their implantation technique (LIS vs CMS). Only centrifugal devices were included. RHF was defined as severe or severe acute RHF according to the 2013 Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definition. Logistic multivariate regression and propensity score‒matched analyses were performed to account for confounding.
Overall, 427 implantations occurred during the study period, with 305 patients implanted using CMS and 122 using LIS. Pre-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) use was more common in the CMS group; off-pump implantation was more common in the LIS group. Other pre-implant variables, including age, creatinine, hemodynamics, and tricuspid regurgitation, did not differ between the 2 groups. Post-operative RHF was less common in the patients who underwent LIS than in those who underwent CMS as was post-operative right ventricular assist device (RVAD) use. LIS remained associated with less RHF in the multivariate analysis. After propensity score matching conditional for age, sex, INTERMACS profile, ECMO, and IABP use in a ratio of 2:1 (CMS to LIS), RHF (29.9% vs 18.6%, p = 0.001) and the need for post-operative RVAD (18.6% vs 8.2%; p = 0.009) remained more common in the CMS group than in the LIS group. There were no significant differences in survival up to 1 year between the groups.
LIS may be associated with less RHF after LVAD implantation compared with CMS. Despite the possible reduction in RHF, there was no difference in 1-year survival. LIS is an alternative to traditional CMS.
传统的正中胸骨切开术（CMS）仍然是植入左心室辅助装置（LVAD）的标准技术。最近的研究表明，微创手术（LIS）可能是有益的；然而，关于右心衰竭（RHF）差异的数据并不充分。本研究旨在确定与 CMS 相比，LIS 对 LVAD 植入后 RHF 结局的影响。
这是一项在 5 个中心进行的国际多中心回顾性队列研究。患者根据植入技术（LIS 与 CMS）分组。仅纳入离心式装置。RHF 根据 2013 年机械循环支持机构间注册（INTERMACS）定义定义为严重或严重急性 RHF。采用逻辑多元回归和倾向评分匹配分析来控制混杂因素。
研究期间共进行了 427 例植入术，其中 305 例采用 CMS 植入，122 例采用 LIS 植入。CMS 组中术前体外膜肺氧合（ECMO）和主动脉内球囊泵（IABP）的使用率较高；LIS 组中无泵植入术的比例较高。其他术前变量，包括年龄、肌酐、血液动力学和三尖瓣反流，在两组间无差异。与 CMS 组相比，LIS 组术后 RHF 发生率较低，术后右心室辅助装置（RVAD）使用率也较低。多变量分析显示，LIS 与术后 RHF 相关。在年龄、性别、INTERMACS 谱、ECMO 和 IABP 使用率按 2:1（CMS 对 LIS）进行倾向评分匹配条件下，RHF（29.9%对 18.6%，p=0.001）和术后需要 RVAD（18.6%对 8.2%；p=0.009）的发生率在 CMS 组仍高于 LIS 组。两组在 1 年内的生存率无显著差异。
与 CMS 相比，LIS 可能与 LVAD 植入后 RHF 发生率较低相关。尽管 RHF 可能减少，但 1 年生存率无差异。LIS 是 CMS 的替代方法。
