Acuity Matters: INTERMACS Profile for Left Ventricular Assist Device Patients Implanted via Sternal-Sparing Approach

Purpose Patient acuity as assessed by INTERMACS profile is significantly correlated to postoperative outcomes for patients undergoing LVAD implantation via median sternotomy. The prognostic utility of INTERMACS profile for the sternal-sparing (SS) approach has yet to be determined. Methods This retrospective, single center study included consecutive patients implanted with a fully magnetically levitated LVAD via the SS approach between February 2018 through June 2019. Patients were compared based on preoperative INTERMACS profile: higher risk (HR) profiles one and two versus lower risk (LR) profiles three or higher. The primary outcome was six-month survival free from disabling stroke or pump exchange. Results Of the 97 total patients implanted via the SS technique, 40 (41%) were HR and 57 (59%) were LR. Besides INTERMACS profile, baseline patient characteristics were similar between cohorts including age (p=0.558), gender (p>0.999) and etiology of heart failure (p=0.224). Postoperatively, the LR cohort had fewer complications and were more likely to be discharged to home (Table 1). Time in the ICU and overall postoperative hospital length of stay were significantly shorter for the LR cohort. Primary outcome was achieved in 96.5% LR vs 82.5% HR cohorts (p=0.015). Conclusion Preoperative INTERMACS profile is correlated with postoperative outcomes for the sternal-sparing approach. Lower risk patients who undergo sternal-sparing implantation demonstrate low rates of complications with excellent mid-term survival. Further research is needed to define the optimal timing of LVAD implantation.