Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.
J Card Surg. 2021 Jul;36(7):2342-2347. doi: 10.1111/jocs.15562. Epub 2021 Apr 16.
Left ventricular assist devices (LVAD) are standardly implanted via full sternotomy. Nonsternotomy approaches are gaining popularity, but potential benefits of this approach have not been well-studied. We hypothesized that LVAD implantation by bi-thoracotomy (BT) would demonstrate smaller and more consistent inflow cannula angles leading to improved postoperative outcomes compared to sternotomy.
Charts of patients who underwent LVAD implantation between June 2018 and June 2020 at a single academic institution were retrospectively reviewed. Patient demographics, surgical approach (sternotomy vs. BT), laboratory values, and postoperative course were compared. The inflow cannula angle was measured on the first chest radiograph available postoperatively.
Of 40 patients studied, BT approach was used in 17 (42.5%). Mean inflow cannula angles were smaller in BT patients (23.0 vs. 37.1 degrees, p = .018) and had a smaller standard deviation (13.8 vs. 20.3). Excluding patients who went on to receive a heart transplant or died in the same hospitalization, there was no difference in median length of hospital stay after surgery (16.0 vs. 17.5 days, p = .768). However, BT patients required fewer days of postoperative inotrope support (4.0 vs. 7.0 days, p = .012).
Our data suggest inflow cannula angles are smaller and more consistent with the BT approach, which leads to a shorter duration of postoperative inotropic support. This finding may suggest improved right heart function following LVAD implant via BT approach. Further study is warranted to determine additional benefits of the BT approach.
左心室辅助装置（LVAD）通常通过完全胸骨切开术植入。非胸骨切开术方法越来越受欢迎，但这种方法的潜在益处尚未得到充分研究。我们假设与胸骨切开术相比，经双开胸（BT）方法植入 LVAD 会导致更小且更一致的流入管角度，从而改善术后结果。
回顾性分析了 2018 年 6 月至 2020 年 6 月在一家学术机构接受 LVAD 植入的患者的病历。比较患者的人口统计学特征、手术方法（胸骨切开术与 BT）、实验室值和术后过程。在术后可获得的第一张胸部 X 光片上测量流入管角度。
在研究的 40 名患者中，BT 方法用于 17 名（42.5%）。BT 患者的流入管角度较小（23.0°对 37.1°，p=0.018），标准差较小（13.8°对 20.3°）。排除随后接受心脏移植或在同一次住院期间死亡的患者后，术后住院时间中位数无差异（16.0 对 17.5 天，p=0.768）。然而，BT 患者术后需要接受更少天数的正性肌力支持（4.0 对 7.0 天，p=0.012）。
我们的数据表明，BT 方法的流入管角度更小且更一致，从而导致术后正性肌力支持的持续时间更短。这一发现可能表明通过 BT 方法植入 LVAD 后右心功能得到改善。需要进一步研究以确定 BT 方法的其他益处。
