Right ventricular function following sternotomy versus a less-invasive approach for left ventricular assist device implant: Retrospective cohort study

Objectives Durable left ventricular assist device (LVAD) implantation is traditionally performed via median sternotomy (MS). Less-invasive implantation may lower the incidence of post-implant right ventricular failure (RVF). Our primary objective was to determine whether less-invasive implantation reduces the odds of severe RVF compared to MS. Design Retrospective cohort study. Setting St. Paul's Hospital, Vancouver, BC, Canada. Participants 198 adult patients between January 2008 and August 2021. Interventions Isolated LVAD implantation either via median sternotomy or via a less-invasive surgical approach. Measurements and Main Results Multivariable logistic regression was used to adjust for confounders. A sensitivity analysis using inverse probability of treatment weighting (IPTW) analysis based on propensity scores was conducted.172 patients were analyzed. 54% (94/172) underwent LVAD implantation via MS, and 45% (78/172) via less-invasive approaches. Age, sex and comorbidities were comparable, but the MS group tended to be more critically ill prior to surgery. After adjusting for confounders, less-invasive approaches did not show significant protection against severe post-implant RVF compared to MS (adjusted OR 0.53; 95% CI 0.20-1.44; p = 0.21). However, patients undergoing less-invasive techniques had reduced adjusted odds of 30-day mortality (OR 0.29; 95% CI 0.09-0.99); p = 0.049). No observed benefit of less-invasive approaches over MS for major bleeding, prevention of blood product transfusion, and listing for transplantation. Conclusions No reduction in the odds of severe RVF following LVAD implantation using less-invasive approaches versus MS. However, we found improved odds of 30-day survival in the less-invasive group. The underlying mechanism requires further investigation.