Does Lateral Approach Preserve the Right Ventricular Function after HeartMate 3 Insertion?
Academic Article
Overview
abstract
OBJECTIVES: Lateral thoracotomy (LT) approach may preserve the right ventricular (RV) function after left ventricular assistive device (LVAD) implantation. This study evaluated the short- and long-term RV function using echocardiography after LVAD implantation via LT or median sternotomy (sternotomy). METHODS: The patients who underwent HeartMate 3 implantation were retrospectively reviewed. The RV function was assessed before and one month and one year after LVAD implantation. The primary and secondary outcomes were all-cause mortality and a composite of death or readmission due to RV failure, respectively. RESULTS: Of the 195 patients, 55 (28%) underwent LT and 140 (72%) underwent sternotomy. There were no significant differences in the preoperative RV geometry or function. One month after the LVAD implantation, the LT group had a smaller RV end-diastolic dimension (42 [29-48] mm vs 47 [42-52] mm; p = 0.003) and RV end-diastolic area (25 [21-28] cm2 vs 29 [24-36] cm2; p < 0.001), and a greater RV fractional area change (30 [25-34] % vs 28 [23-31] %; p = 0.04) and peak systolic tissue velocity (8 [7-9] cm/s vs 7 [6-8] cm/s; p = 0.01). Twenty-four patients died and 46 met the composite end-point. Kaplan-Meier curve analysis did not reveal significant differences between LT and sternotomy in the two-year survival (93% vs 83%; log-rank test, p = 0.28) and adverse event rate (76% vs 71%; log-rank test, p = 0.65). CONCLUSIONS: LT approach yielded a better-preserved RV function at one month; however, there were no significant differences in the two-year survival and adverse event rates.
