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Is resternotomy a risk for continuous-flow left ventricular assist device outcomes?
Athanasios Tsiouris1, Robert J Brewer, Jamil Borgi
1Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA. atsiour1@hfhs.org
Journal of Cardiac Surgery
|December 18, 2012
Summary
Resternotomy is a safe procedure for patients receiving continuous-flow left ventricular assist devices (LVADs), with similar survival and complication rates compared to first-time sternotomy. This finding supports the safety of reoperative cardiac surgery for LVAD implantation.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
- Transplantation Medicine
Background:
- Increasing number of patients require resternotomy for cardiac procedures.
- Left ventricular assist device (LVAD) implantations frequently involve reoperative sternotomy.
- Published data suggest sternal reentrance is generally safe.
Purpose of the Study:
- To compare outcomes of continuous-flow LVAD implantation in patients undergoing primary sternotomy versus resternotomy.
- To evaluate if resternotomy is an independent predictor of adverse outcomes.
- To assess survival, morbidity, and hemodynamic performance in these patient groups.
Main Methods:
- Retrospective analysis of 100 patients receiving HeartMate II or HeartWare LVADs from 2006-2012.
- Patients stratified into primary sternotomy (n=71) and resternotomy (n=29) groups.
- Statistical comparison using t-tests, chi-square tests, Cox models, and log-rank tests.
Main Results:
- Resternotomy patients were older, with higher rates of ischemic cardiomyopathy and COPD.
- Survival rates at 30, 180, and 360 days were similar between groups (e.g., 82.8% vs. 88.7% at 360 days).
- Re-exploration for bleeding was higher in the resternotomy group (17.2% vs. 4.2%), but transfusion needs and other complications were comparable.
Conclusions:
- Resternotomy for continuous-flow LVAD implantation demonstrates comparable survival to primary sternotomy.
- No significant differences in postoperative complications or hemodynamic measurements were observed.
- Findings support the safety of resternotomy in the context of LVAD therapy.
