Tufts University School of Medicine, 145 Harrison Ave., Boston, MA, 02111, USA.
Division of Cardiac Surgery, Tufts Medical Center, 800 Washington St., South Building, 6th Floor, Boston, MA, 02111, USA.
J Artif Organs. 2021 Sep;24(3):312-319. doi: 10.1007/s10047-021-01250-y. Epub 2021 Mar 19.
Left ventricular assist device (LVAD) implantations have traditionally been approached through a full median sternotomy (FS). Recently, a minimally invasive left thoracotomy (LT) approach has been popularized. This study sought to compare the outcomes of FS and LT patients post-primary LVAD implantation and post-subsequent heart transplant (HT). This was a single-center retrospective study. 83 patients who underwent primary centrifugal durable LVAD implantation from January 2014 to June 2018 were included (FS, n = 41; LT, n = 42). 41 patients had a subsequent HT (FS, n = 19; LT, n = 22). Pre-operative patient demographics, intraoperative variables, post-operative 1-year survival, length of hospital stay, complications, and outcomes for LVAD implantation and following HT were analyzed. Intraoperative data showed that the LT group had a 23.4% longer mean LVAD implant surgical time (p < 0.01). One-year post-LVAD survival was similar between the two groups (p = 0.05). Complication rates, with the exception of the rate of hemorrhagic stroke (p = 0.04) post-LVAD implant were similar. One-year survival post-HT was similar between groups (p = 0.35). Complication rates and mean length of hospital stay were also similar (p = 1.0) post-HT. Our study demonstrated that LT approach does not negatively affect post-LVAD implantation or post-HT outcomes. Further, larger studies may determine more detailed effects of LT approach.
左心室辅助装置 (LVAD) 植入术传统上采用经胸骨正中切开术 (FS)。最近，微创左开胸术 (LT) 已得到普及。本研究旨在比较 FS 和 LT 患者在初次 LVAD 植入术后和随后进行心脏移植 (HT) 后的结局。这是一项单中心回顾性研究。纳入 2014 年 1 月至 2018 年 6 月期间接受初次离心式耐用型 LVAD 植入术的 83 例患者 (FS 组 41 例，LT 组 42 例)。41 例患者随后接受 HT (FS 组 19 例，LT 组 22 例)。分析了术前患者人口统计学资料、术中变量、术后 1 年生存率、住院时间、并发症以及 LVAD 植入术和随后 HT 的结果。术中数据显示，LT 组的 LVAD 植入手术时间平均长 23.4% (p<0.01)。两组术后 1 年生存率相似 (p=0.05)。除 LVAD 植入术后出血性卒中发生率外 (p=0.04)，两组并发症发生率相似。两组术后 1 年 HT 生存率相似 (p=0.35)。HT 后并发症发生率和平均住院时间也相似 (p=1.0)。本研究表明，LT 方法不会对 LVAD 植入术后或 HT 后结局产生负面影响。进一步的大样本研究可能会确定 LT 方法的更详细影响。
