J. Ehab1, E. Hauptman1, R. Chandra1, R. Whitlock2, S. Yeganeh2, M. Jessen2, C. Heid2, M. Peltz2 1University Of Texas Southwestern Medical Center, Department Of Surgery, Dallas, TX, USA 2University Of Texas Southwestern Medical Center, Department Of Cardiothoracic Surgery, Dallas, TX, USA
Introduction: Left ventricular assist devices (LVAD) can be used to bridge patients to orthotropic heart transplant (OHT). Sternal sparing (ssLVAD) is an emerging implantation technique which may result in less bleeding, lower rates of right ventricular dysfunction, and quicker recovery. The aim of this study was to assess the impact of ssLVAD on perioperative outcomes of future OHT.
Methods: A single center retrospective review of LVAD explant OHT cases was performed between the years 2014-2023. Patients were stratified into ssLVAD vs traditional sternotomy LVAD (sLVAD). Patient demographics, operative procedure, post-operative course, pathological data, laboratory values, short- and long-term outcomes were analyzed. Categorical data are presented as numbers with proportions and continuous variables as medians with interquartile ranges.
Results:A total of 81 patients (69 sLVAD, 12 ssLVAD) were included in the analysis. There were no differences in demographic or baseline characteristics between the cohorts. There were no differences in operative time, cardiopulmonary bypass time, however sLVAD patients trended towards requiring higher intraoperative pRBC transfusions (6 vs 2, p.18). Rates of post-operative surgical site infections were similar between cohorts (8.6% vs 10.1%, p=.46). There were no differences in rates of major post-operative complications including renal failure (p=.53), cardiac arrest (p=.48), or cerebrovascular accident (p=.06). There was no difference in 30-day survival between patients who underwent either sLVAD (92.7%) or ssLVAD (100%) (p=.24) (Figure 1)
Conclusion:
LVAD explant and OHT are feasible after ssLVAD with comparable rates of major perioperative complications and similar 30-day mortality. OHT after ssLVAD and may have a trend towards less blood product transfusion requirements and potentially improved 30-day survival.