Nozdrzykowski Michal, Bauer Jessica-Marie, Schulz Uwe, Jawad Khalil, Bireta Christian, Eifert Sandra, Sandri Marcus, Jozwiak-Nozdrzykowska Joanna, Borger Michael A, Saeed Diyar
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Department of Cardiology, Leipzig Heart Center, Leipzig, Germany.
Front Cardiovasc Med. 2023 May 11;10:974527. doi: 10.3389/fcvm.2023.974527. eCollection 2023.
Several studies have shown the potential advantage of less-invasive surgery (LIS) for left ventricular assist device (LVAD) implantation. This study aims to determine the impact of LIS on stroke and pump thrombosis events after LVAD implantation.
Between January 2015 and March 2021, 335 consecutive patients underwent LVAD implantation using either conventional sternotomy (CS) or the LIS technique. Patient characteristics was prospectively collected. All patients were followed up until October 2021. Logistic multivariate regression and propensity-matched analyses were performed to account for confounding factors.
A total of 242 patients ( = 32; 13.0%) underwent LVAD implantation with CS and 93 patients ( = 8; 8.6%) with the LIS approach. Propensity matching generated two groups, including 98 patients in the CS group and 67 in the LIS group. Intensive care unit stay for the LIS group patients was significantly shorter than that for the CS group patients [2 (IQR: 2-5) days vs. 4 (IQR: 2-12) days, < 0.01]. There were no significant differences in the incidence of stroke events (14% in CS vs. 16% in the LIS group; = 0.6) or in pump thrombosis (6.1% in CS vs. 7.5% in the LIS group; = 0.8) between the groups. The hospital mortality rate in the matched cohort was significantly lower in the LIS group (7.5% vs. 19%; = 0.03). However, the 1-year mortality rate showed no significant difference between both groups (24.5% in CS and 17.9% in LIS; = 0.35).
The LIS approach for LVAD implantation is a safe procedure with potential advantage in the early postoperative period. However, the LIS approach remains comparable to the sternotomy approach in terms of postoperative stroke, pump thrombosis, and outcome.
多项研究显示了左心室辅助装置（LVAD）植入采用微创手术（LIS）的潜在优势。本研究旨在确定LIS对LVAD植入术后中风和泵血栓形成事件的影响。
在2015年1月至2021年3月期间，335例连续患者采用传统胸骨切开术（CS）或LIS技术进行LVAD植入。前瞻性收集患者特征。所有患者随访至2021年10月。进行逻辑多因素回归和倾向匹配分析以考虑混杂因素。
共有242例患者（n = 32；13.0%）采用CS进行LVAD植入，93例患者（n = 8；8.6%）采用LIS方法。倾向匹配产生两组，包括CS组98例患者和LIS组67例患者。LIS组患者的重症监护病房停留时间明显短于CS组患者[2（四分位间距：2 - 5）天对4（四分位间距：2 - 12）天，P < 0.01]。两组之间中风事件发生率（CS组为14%，LIS组为16%；P = 0.6）或泵血栓形成发生率（CS组为6.1%，LIS组为7.5%；P = 0.8）无显著差异。匹配队列中LIS组的医院死亡率显著低于CS组（7.5%对19%；P = 0.03）。然而，两组之间的1年死亡率无显著差异（CS组为24.5%，LIS组为17.9%；P = 0.35）。
LVAD植入的LIS方法是一种安全的手术方法，在术后早期具有潜在优势。然而，LIS方法在术后中风、泵血栓形成和结局方面仍与胸骨切开术方法相当。
