Results
Between June 2018 and June 2020, 44 patients underwent LVAD implantation. Four of these patients were undergoing device exchange and were excluded. Of the 40 included, 17 (42.5%) devices were placed by BT approach and 23 (57.5%) by sternotomy. The BT and sternotomy groups did not have significant differences in median age at the time of operation (62.0 vs. 55.0 years, p=0.274), sex (14 vs. 19 males, p>0.99), or mean BMI (27.4 vs. 30.0, p=0.170) (Table 1). Likewise, the groups did not demonstrate significant differences in preoperative comorbidities or laboratory values, except for cardiac index (2.2 vs. 1.8 liters/min/m2, p=0.020) and serum sodium (137.7 vs. 134.7 mEq/L, p=0.006) (Table 1). There was no difference in the most recent ejection fraction prior to surgery (15.0 vs. 20.0%, p=0.460) or in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile (3.0 vs. 3.0, p=0.341) (Table 1). Furthermore, there was no difference in the percentage of patients who required preoperative hemodynamic support in the form of inotropes, intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO), with 76.5% of BT and 82.6% of sternotomy patients requiring one or more of these modalities (p=0.702) (Table 1). Lastly, more BT patients were planned as destination therapy (DT) than sternotomy patients (88.2% vs. 52.2%, p=0.020) (Table 1).
In comparing postoperative outcomes, BT patients demonstrated a lower median intraoperative blood loss than sternotomy patients (0.0 vs. 100.0 mL), though these values did not reach statistical significance (p=0.096) (Table 2). Excluding patients who went on to receive a heart transplant (n=8) or died (n=14), there was no difference in median length of hospital stay after surgery (16.0 vs. 17.5 days, p=0.768). BT patients required fewer days of postoperative inotrope support (4.0 vs. 7.0 days, p=0.012). Additionally, the mean inflow cannula angles measured on the first postoperative chest radiograph were smaller in BT patients (23.0 vs. 37.1 degrees, p=0.018) and had a smaller standard deviation (13.8 vs. 20.3).