Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Heart Lung Transplant. 2021 Sep;40(9):990-997. doi: 10.1016/j.healun.2021.06.001. Epub 2021 Jun 11.
Historically, obesity was considered a relative contraindication to left ventricular assist device (LVAD) implantation with less invasive surgery (LIS). The present study aimed to compare the outcomes of obese patients who underwent LVAD implantation through LIS with those who received full sternotomy (FS) implantation.
We retrospectively reviewed all patients implanted with HeartMate 3 LVAD in our institution between September 2015 and June 2020. Obese patients (BMI ≥ 30 kg/m) were included and dichotomized based on surgical approach into the FS or LIS cohort.
Of 231 implanted patients, 107 (46%) were obese and included in the study. FS was performed in 26 (24%) patients and LIS approach in 81 (76%) patients. Preoperative patient characteristics were similar between the cohorts. Postoperatively, patients in LIS cohort had less bleeding (p = 0.029), fewer transfusions (p = 0.042), shorter duration of inotropic support (p = 0.049), and decreased incidence of severe RV failure (11.1% vs 30.8%, p = 0.028). Survival to discharge for the obese population was 87.5% overall and did not differ based on an approach (91.4% LIS vs 76.9% FS, p = 0.079). More LIS patients were discharged home (60.0% vs 82.4%, p = 0.041) rather than to rehabilitation center.
Our results showed that the LIS approach in obese patients is associated with fewer postoperative complications and a trend towards better short-term survival. These results suggest that less invasive LVAD implantation is a safe and effective approach for obese patients. Future prospective randomized trials are required to substantiate these results.
从历史上看，肥胖被认为是左心室辅助装置（LVAD）植入术的相对禁忌症，尤其是微创手术（LIS）。本研究旨在比较通过 LIS 行 LVAD 植入术的肥胖患者与接受完全胸骨切开术（FS）植入术的患者的结局。
我们回顾性分析了 2015 年 9 月至 2020 年 6 月期间在我院植入 HeartMate 3 LVAD 的所有患者。纳入肥胖患者（BMI≥30kg/m），并根据手术方式分为 FS 或 LIS 组。
在 231 例植入患者中，107 例（46%）为肥胖患者，纳入本研究。26 例（24%）患者行 FS，81 例（76%）患者行 LIS 手术。两组患者术前一般特征相似。术后，LIS 组患者出血量较少（p=0.029），输血量较少（p=0.042），正性肌力支持时间较短（p=0.049），严重右心室衰竭发生率降低（11.1%比 30.8%，p=0.028）。肥胖人群的总出院生存率为 87.5%，与手术方式无关（LIS 组 91.4%比 FS 组 76.9%，p=0.079）。更多的 LIS 患者出院回家（60.0%比 82.4%，p=0.041）而不是康复中心。
我们的研究结果表明，对于肥胖患者，LIS 方法与较少的术后并发症相关，并且有改善短期生存率的趋势。这些结果表明，微创 LVAD 植入术对于肥胖患者是一种安全有效的方法。需要前瞻性随机试验来证实这些结果。
