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Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation

Konstantin Zhigalov1, Marcin Szczechowicz1, Ahmed Mashhour1

  • 1Department of Cardiac Surgery, Klinikum Oldenburg, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.

The Thoracic and Cardiovascular Surgeon
|January 9, 2019
PubMed

Insights

Previous sternotomy significantly impacts left ventricular assist device (LVAD) outcomes. Patients with prior sternotomy experienced lower survival rates and increased complications, including device-related issues and organ dysfunction.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • Previous sternotomy is a common surgical history for patients requiring advanced heart failure therapy.
  • Left Ventricular Assist Devices (LVADs) are crucial for end-stage heart failure management.
  • The influence of prior sternotomy on LVAD outcomes requires detailed investigation.

Purpose of the Study:

  • To evaluate the impact of previous sternotomy (PS) on the outcomes of patients receiving three distinct types of left ventricular assist devices (LVADs).
  • To compare survival rates and adverse event profiles between LVAD recipients with and without a history of sternotomy.

Main Methods:

  • A retrospective analysis of 121 patients implanted with HeartMate II, HeartWare, or HeartMate III LVADs between June 2007 and February 2018.
  • Patients were categorized into previous sternotomy (PS) and non-PS groups.
  • Propensity score matching created 44 comparable patient pairs for analysis of primary (overall survival) and secondary (adverse events) endpoints.

Main Results:

  • Overall survival rates were significantly lower in the PS group compared to the non-PS group at 1, 2, and 5 years post-implantation (p=0.036).
  • The PS group exhibited a higher incidence of intraoperative short-term right ventricular assist device implantation (22.7% vs 6.8%, p=0.034).
  • Increased rates of hepatic dysfunction (20.5% vs 4.5%, p=0.025) and acute kidney dysfunction (40.9% vs 20.5%, p=0.032) were observed in the PS group.

Conclusions:

  • Previous sternotomy is a significant predictor of increased mortality and morbidity following LVAD implantation.
  • The findings underscore the importance of considering prior sternotomy in risk stratification and perioperative management of LVAD candidates.
Abstract

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