Less is better? Comparing effects of median sternotomy and thoracotomy surgical approaches for left ventricular assist device implantation on postoperative outcomes and valvulopathy.
concomitant valve repair
hemisternotomy
lateral thoracotomy
left ventricular assist device
less invasive
median sternotomy
tricuspid regurgitation
valvulopathy
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
Feb 2024
Feb 2024
Historique:
received:
27
12
2021
revised:
06
04
2022
accepted:
25
04
2022
medline:
15
1
2024
pubmed:
26
8
2022
entrez:
25
8
2022
Statut:
ppublish
Résumé
Our objective was to compare outcomes after left ventricular assist device implantation performed via median sternotomy or lateral thoracotomy. We retrospectively analyzed 222 adult patients with the HeartMate3 (Abbott Lab) left ventricular assist device implanted between November 2014 and November 2021. Outcomes stratified by surgical approach were evaluated in propensity score-matched groups. The primary outcome was 1-year survival. Secondary outcomes included in-hospital morbidity and mortality, readmissions, and significant valvular regurgitation. Our cohort consisted of 60 patients (27%) who underwent lateral thoracotomy and 162 patients (73%) who underwent median sternotomy. Propensity score matching compared 45 patients who underwent lateral thoracotomy with 68 patients who underwent median sternotomy. There were no differences in intensive care unit or hospital stay duration (median, 10 vs 11 days, P = .58; 46 vs 40 days, P = .279), time to extubation (median, 2 days, P = .627), vasoactive-inotropic scores at intensive care unit arrival (18.20 vs 16.60, P = .654), or in-hospital mortality (2 [5%] vs 4 [6.1%] patients, P = 1). One-year survival (95.56% vs 90.61%, P = .48) and all-cause hospital readmission rate (Gray's test: P = .532) were also comparable. Patients who underwent lateral thoracotomy had significantly less early right ventricular failure (24.4% vs 53.7%, P = .004), although they had more follow-up tricuspid regurgitation (17.6% vs 0%, P = .030) and volume overload readmissions (Gray's test: P = .0005). Our data suggest that lateral thoracotomy is a safe although not necessarily superior alternative to median sternotomy for HeartMate 3 implantation in the perioperative and postoperative periods, because it precludes concomitant tricuspid valve repairs and may be associated with increased risk of late tricuspid regurgitation and volume overload readmissions.
Identifiants
pubmed: 36008179
pii: S0022-5223(22)00528-1
doi: 10.1016/j.jtcvs.2022.04.036
pmc: PMC9669283
mid: NIHMS1831948
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
731-743.e3Subventions
Organisme : NHLBI NIH HHS
ID : T35 HL007616
Pays : United States
Informations de copyright
Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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