Left Ventricular Assist Device Implantation in Patients with Previous Open-Heart Surgery: Comparison of Median Sternotomy and Lateral Thoracotomy

TL;DR

This study compares two surgical approaches for implanting heart support devices in patients who have had previous heart surgery, finding one method reduces operation time but not recovery time.

Contribution

The study provides new comparative data on median sternotomy versus lateral thoracotomy for LVAD implantation in reoperative cardiac surgery.

Findings

Lateral thoracotomy reduced operation duration and cardiopulmonary bypass time compared to median sternotomy.

There was no significant difference in postoperative pain, blood product use, ICU stay, or complications between the two approaches.

Abstract

Reoperative cardiac surgery is associated with a higher risk of complications
due to technical difficulties compared to the first-time surgery. This study
aims to compare the early outcomes of median sternotomy (MS) and lateral
thoracotomy (LT) procedures in patients with a history of previous
open-heart surgery who underwent left ventricular assist device (LVAD)
implantation with cardiopulmonary bypass (CPB).

A retrospective analysis was conducted on 36 patients who received LVAD
implants for end-stage heart failure between November 2012 and June 2015.
The patients were divided into Group 1 (MS, n = 18) and Group 2 (LT, n =
18).

The mean age of the patients was 57.2 ± 9.4 years (range: 24 - 70
years), and only 8.3% were female. Demographic data, preoperative
characteristics, use of blood products, anesthetic drugs, and complications
were similar in both groups (P > 0.05). The MS group had significantly
longer operation duration (101 ± 46 minutes vs. 70 ± 20
minutes, P = 0.038) and CPB time (328 ± 79 minutes vs. 265 ±
47 minutes, P = 0.048) compared to the LT group. Postoperative analgesic
consumption and pain scores were similar between the two groups (P >
0.05).

In patients with a history of previous cardiac surgery, LVAD implantation
with LT through CPB demonstrated favorable outcomes regarding reduced
operation duration and CPB time. However, it did not positively impact the
duration of stay in the intensive care unit, hospital stay, use of blood
products, and complications.

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