Less invasive surgical implant strategy and right heart failure after LVAD implantation
Section snippets
Study design
A multicenter retrospective cohort study was conducted across 5 centers, including the University Hospital of Düsseldorf (Düsseldorf, Germany) (n = 121), the Leipzig Heart Center (Germany) (n = 201), the University of Minnesota Medical Center (Minneapolis, MN) (n = 38), the Medical University of South Carolina (Charleston, SC) (n = 10), and the Johns Hopkins School of Medicine (Baltimore, MD) (n = 57). The study included 427 patients (aged >18 years) who underwent LVAD implantation between
Study population
Overall, 427 patients underwent an LVAD implantation; 305 implantations were performed through CMS and 122 by LIS. The CMS group consisted of 140 HM3 and 165 HVADs compared with 46 HM3 and 76 HVADs in the LIS group. There was no difference in the mean age, sex, body mass index, history of diabetes mellitus, or history of hypertension when comparing the patients in the CMS group with those in the LIS group. In addition, there was no significant difference in the baseline hemodynamic parameters
Discussion
This study represents the largest multicenter effort to compare CMS with LIS and their associations with RHF. We show that a less invasive LVAD implant strategy may be associated with a fewer instances of RHF. Although RHF was associated with excess mortality, all-cause mortality was not different between CMS and LIS groups in up to 1-year follow-up. In total, these data support an LIS strategy as an alternative to CMS implantation.
When considering a right ventricular (RV)-protective strategy,
Disclosure statement
R.C. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include serving on a speaker's bureau for Abbott and on the heart failure advisory board for Medtronic. Her spouse is employed by Medtronic. R.J. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include serving as a consultant to Medtronic and Abbott. L.L. reports no direct conflicts of interest relevant to this manuscript. Other general conflicts include
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2024, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :RHF is a major cause of morbidity and mortality after LVAD implantation, occurring in 10% to 40% of cases.24 A recent multicenter study by Saeed and colleagues6 demonstrated decreased incidence of RHF after less-invasive LVAD implantation compared with MS. Previous studies have also shown a decreased in RV failure associated with less-invasive implantation techniques.25-27 Although the mechanism of this protective effect is not fully understood, it is hypothesized to be related to the preservation of the pericardium, which helps maintain normal RV geometry, limit dilatation, and, in allowing the heart to remain in its native anatomic position, reduce the risk of RV free-wall tethering and hypoperfusion.6,27,28
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