Left Thoracotomy Upper Hemisternotomy Left Ventricular Assist Device (LVAD) Implantation Offers Safe, Durable Option for Patients with Prior Sternotomy Undergoing LVAD Implantation

Purpose Increasingly, patients undergoing LVAD implantation have had previous cardiac surgery, and re-operative sternotomy LVAD implantation can pose certain technical challenges. The approval of the thoracotomy approach for LVAD implantation potentially offers increased flexibility of access and may mitigate some of these technical challenges. Thus we reviewed our series of patients with previous sternotomy and who underwent left thoracotomy and upper hemisternotomy LVAD implantation. Methods Data were compiled on all patients who had consented to be included in the Advanced Heart Failure Registry, at Vanderbilt University Medical Center, between January 2013 and October 2018. Patients who had had previous sternotomy and thoracotomy HeartWareTM HVAD LVAD implantation were included in the analysis. Patients who had undergone thoracotomy HeartMate II (N=3), or off-pump thoracotomy HVAD implantation (N = 9) were excluded from the analysis. The operative technique for all patients involved a limited left anterolateral thoracotomy with an upper hemi-sternotomy anastomosis to the ascending aorta. Preoperative, Intra-operative and post-operative clinical and VAD specific variables were reported. Data regarding clinical end points were analyzed at 30 days and one year following implant. Results 19 patients satisfied the inclusion criteria, and their characteristics are described in Table 1. One patient died 11 days post LVAD implantation due to multi-system organ failure. This patient was INTERMACS 1 at implant with multi-organ failure pre-operatively. All other patients were either transplanted or still on LVAD support one year following implant. Conclusion The use of the left thoracotomy upper hemisternotomy approach for LVAD implantation in patients with previous sternotomy is a safe alternative to re-operative sternotomy.