Less Invasive Surgical Implant Strategy is Associated with Significant Reduction in INTERMACS Defined Right Heart Failure Following LVAD Implantation

PURPOSE: Conventional median sternotomy (CMS) is still the standard technique utilized to implant left ventricular assist devices (LVAD). Recent studies suggest that less invasive surgery (LIS) may have advantages; however, robust data on differences in right heart failure (RHF) is lacking. This study aimed to determine the impact of LIS versus CMS on RHF outcomes following LVAD implantation. METHODS: An international multi-centre retrospective cohort study was conducted, including 5 centres. Patients were grouped according to their implantation technique (LIS vs. CMS). Only centrifugal devices were included. RHF was defined according to the INTERMACS definition; sub-analyses for inter-centre differences and propensity-score analyses were also performed. RESULTS: Overall, 405 implants occurred during the study period, with 305 patients implanted via CMS and 100 via LIS. Most pre-implant variables including mean age at implantation, sex, serum creatinine, right atrial pressure, PAPi, cardiac index, and baseline tricuspid regurgitation did not differ between the two groups. RHF grade after LVAD implantation was significantly worse in CMS patients than in LIS patients. Fourty-six, 21%, and 34% of the patients in the CMS group had none, mild-to-moderate, and severe-severe acute RHF compared to 76%, 10%, and 14% in the LIS group respectively, p<0.001(Figure 1). After propensity matching for age, sex, and INTERMACS class in a ratio of 2:1 (CMS:LIS), severe-to-severe acute RHF remained significantly more common in the CMS group (28% vs 14%, p <0.001). There were no significant differences in survival at 90-days between the CMS group and the LIS group (84.6% vs. 88.0%, P=0.40). CONCLUSION: LIS is associated with reduced INTERMACS defined right heart failure following LVAD implantation compared with CMS. The association remained after controlling for severity of pre-implant heart failure.

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