Suzuki Tomoyuki, Ise Hayato, Döpp Robin, Kröpil Patric, Saiki Yoshikatsu, Lichtenberg Artur, Boeken Udo, Aubin Hug, Akhyari Payam, Sugimura Yukiharu
Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Front Cardiovasc Med. 2025 Aug 15;12:1591653. doi: 10.3389/fcvm.2025.1591653. eCollection 2025.
less invasive approach (LIS) has recently become increasingly used for left ventricular assist device (LVAD) implantation. However, the impact of surgical access on pump position and clinical outcomes comparing LIS-LVAD implantation to full sternotomy (ST) has not been well discussed.
Between April 2010 and February 2021, a total of 237 consecutive patients received a LVAD, 76 (32.1%) of whom underwent the LIS approach and 161 (67.9%) of whom underwent ST. The clinical outcomes were retrospectively reviewed, and data of 66 comparable patients from each group extracted by propensity score matching were analyzed. For the analysis of pump position, cannula coronal angle (CCA,°) and pump diaphragm depth (PDD, mm) of LVAD were measured according to postoperative chest x-ray.
The mean age of all patients was 57.7 ± 11.3 years, 204 cases were male (86.1%), and 48 cases resulted in in-hospital death (20.3%). There was no significant impact on clinical outcomes according to surgical approach in matched groups. There was also no significant difference regarding pump position between two different access groups. A larger PDD was associated with both in-hospital death (60.2 ± 25.8 vs. 43.4 ± 31.3, < 0.01) and death on LVAD (55.4 ± 28.1 vs. 41.7 ± 31.5, < 0.01). Receiver operating characteristic (ROC) curve analyses revealed that PDD was a significant predictor of mortality in LIS approach.
Our results indicate that LVAD implantation via LIS approach is safe yielding comparable outcomes with ST approach. Regarding spatial positioning of LVAD via LIS approach, larger PDD, may predict worse clinical outcomes.
近年来，微创方法（LIS）在左心室辅助装置（LVAD）植入术中的应用越来越广泛。然而，与全胸骨切开术（ST）相比，手术入路对LVAD植入的泵位置和临床结果的影响尚未得到充分讨论。
2010年4月至2021年2月期间，共有237例连续患者接受了LVAD植入，其中76例（32.1%）采用LIS方法，161例（67.9%）采用ST方法。回顾性分析临床结果，并对通过倾向评分匹配从每组中提取的66例可比患者的数据进行分析。为了分析泵位置，根据术后胸部X光测量LVAD的插管冠状角（CCA，°）和泵隔膜深度（PDD，mm）。
所有患者的平均年龄为57.7±11.3岁，204例为男性（86.1%），48例住院死亡（20.3%）。在匹配组中，手术入路对临床结果没有显著影响。两种不同入路组之间的泵位置也没有显著差异。较大的PDD与住院死亡（60.2±25.8 vs. 43.4±31.3，<0.01）和LVAD死亡（55.4±28.1 vs. 41.7±31.5，<0.01）均相关。受试者工作特征（ROC）曲线分析显示，PDD是LIS方法中死亡率的重要预测指标。
我们的结果表明，通过LIS方法植入LVAD是安全的，与ST方法的结果相当。关于通过LIS方法植入LVAD的空间定位，较大PDD可能预示着更差的临床结果。
