From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
ASAIO J. 2021 Aug 1;67(8):845-855. doi: 10.1097/MAT.0000000000001359.
The use of lateral thoracotomy (LT) for implanting left ventricular assist devices (LVADs) is worldwide increasing, although the available evidence for its positive effects compared with conventional sternotomy (CS) is limited. This systematic review and meta-analysis analyzes the outcomes of LT compared with CS in patients undergoing implantation of a centrifugal continuous-flow LVAD. Four databases and 1,053 publications were screened until December 2019. Articles including patients undergoing implantation of a centrifugal continuous-flow LVAD through LT were included. A meta-analysis to compare LT and CS was performed to summarize evidences from studies including both LT and CS patients extracted from the same population. Primary outcome measure was in-hospital or 30-day mortality. Eight studies reporting on 730 patients undergoing LVAD implantation through LT (n = 242) or CS (n = 488) were included in the meta-analysis. Left thoracotomy showed lower in-hospital/30-day mortality (odds ratio [OR]: 0.520, 95% confidence interval [CI]: 0.27-0.99, p = 0.050), shorter intensive care unit (ICU) stay (mean difference [MD]: 3.29, CI: 1.76-4.82, p < 0.001), lower incidence of severe right heart failure (OR: 0.41; CI: 0.19-0.87, p = 0.020) and postoperative right ventricular assist device (RVAD) implantation (OR: 0.27, CI: 0.10-0.76, p = 0.010), fewer perioperative transfusions (MD: 0.75, CI: 0.36-1.14, p < 0.001), and lower incidence of renal failure (OR: 0.45, CI: 0.20-1.01, p = 0.050) and device-related infections (OR: 0.45, CI: 0.20-1.01, p = 0.050), respectively. This meta-analysis demonstrates that implantation of a centrifugal continuous-flow LVAD system via LT benefits from higher short-term survival, less right heart failure, lower postoperative RVAD need, shorter ICU stay, less transfusions, lower risk of device-related infections and kidney failure. Prospective studies are needed for further proof.
经左胸外侧切口（LT）植入左心室辅助装置（LVAD）在全球范围内的应用日益增多，尽管与传统胸骨正中切开术（CS）相比，其具有积极效果的证据有限。本系统评价和荟萃分析分析了 LT 与 CS 在植入离心式连续血流 LVAD 患者中的结果。在 2019 年 12 月之前，筛选了四个数据库和 1053 篇文献。包括通过 LT 植入离心式连续血流 LVAD 的患者的文章。进行荟萃分析以比较 LT 和 CS，以总结从同一人群中提取的同时包括 LT 和 CS 患者的研究中的证据。主要观察指标为住院或 30 天死亡率。有 8 项研究报告了 730 例通过 LT（n = 242）或 CS（n = 488）植入 LVAD 的患者，纳入荟萃分析。左开胸术显示较低的住院/30 天死亡率（比值比[OR]：0.520，95%置信区间[CI]：0.27-0.99，p = 0.050），较短的重症监护病房（ICU）住院时间（平均差[MD]：3.29，CI：1.76-4.82，p < 0.001），较低的严重右心衰竭发生率（OR：0.41；CI：0.19-0.87，p = 0.020）和术后右心室辅助装置（RVAD）植入率（OR：0.27，CI：0.10-0.76，p = 0.010），围手术期输血减少（MD：0.75，CI：0.36-1.14，p < 0.001），肾功能衰竭发生率降低（OR：0.45，CI：0.20-1.01，p = 0.050）和器械相关感染（OR：0.45，CI：0.20-1.01，p = 0.050）。这项荟萃分析表明，通过 LT 植入离心式连续血流 LVAD 系统可获得更高的短期生存率，更少的右心衰竭，更低的术后 RVAD 需要，更短的 ICU 住院时间，更少的输血，降低器械相关感染和肾功能衰竭的风险。需要前瞻性研究进一步证实。
