Minimally invasive surgery for left ventricular assist device implantation is safe and associated with a decreased risk of right ventricular failure

Adrien Carmona; Tam Hoang Minh; Stéphanie Perrier; Clément Schneider; Sandrine Marguerite; Gharib Ajob; Cristinar Mircea; Paul-Michel Mertes; Darmesh Ramlugun; Joseph Atlan; Jean-Jacques Von Hunolstein; Eric Epailly; Jean-Philippe Mazzucotelli; Michel Kindo

doi:10.21037/jtd.2020.02.32

Minimally invasive surgery for left ventricular assist device implantation is safe and associated with a decreased risk of right ventricular failure

J Thorac Dis. 2020 Apr;12(4):1496-1506. doi: 10.21037/jtd.2020.02.32.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France.
² Department of Cardiology, University Hospitals of Strasbourg, Strasbourg, France.
³ Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France.

Abstract

Background: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is associated with significant mortality and morbidity. The objective of this study was to determine pre- and postoperative risk factors associated with the occurrence of RVF after LVAD implantation.

Methods: This retrospective study included 68 patients who received LVADs between 2010 and 2018 either for bridge to transplant (40 patients, 58.8%) or bridge to destination therapy (28 patients, 41.2%). RVF after LVAD implantation was defined according to the INTERMACS classification. The primary endpoint was the occurrence of RVF. The secondary endpoints were hospital mortality and morbidity and long-term survival.

Results: The majority of patients (61.8%) had an INTERMACS profile 1 (36.8%) or 2 (25.0%). The LVAD was implanted either by sternotomy (37 patients, 54.4%) or thoracotomy (31 patients, 45.6%). RVF after LVAD implantation was observed in 32 patients (47.1%). In univariate analysis, an elevated serum glutamic oxaloacetic transaminase (SGOT) (P=0.028) and a high preoperative vasoactive inotropic score (VIS) (P=0.028) were significantly associated with an increased risk of RVF, whereas the implantation of LVAD through a thoracotomy approach was associated with a significant reduction in this risk (P=0.006). The multivariate analysis demonstrated that only the thoracotomy approach was significantly associated with decreased risk of RVF (odds ratio =0.33, 95% confidence interval: 0.17-0.96; P=0.042). Hospital mortality was 53.1% and 5.6% in the RVF and control groups, respectively (P<0.0001). The incidence of stroke and postoperative acute renal failure were significantly increased in the RVF group compared with the control group. The survival after LVAD implantation was 33.5%±9.0% and 85.4%±6.0% at 1 year in the RVF and control groups, respectively (P<0.0001).

Conclusions: LVAD implantation by thoracotomy significantly reduced the risk of postoperative RVF. This surgical approach should, therefore, be favored.

Keywords: Heart failure (HF); artificial heart ventricle; care, postoperative.