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Related Experiment Video

Updated: Jul 13, 2025

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Does lateral approach preserve the right ventricular function after HeartMate 3 insertion?

Hideyuki Hayashi1, Michael Kirschner1, Alice Vinogradsky1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.

Interdisciplinary Cardiovascular and Thoracic Surgery
|October 12, 2023
PubMed
Summary
This summary is machine-generated.

The lateral thoracotomy (LT) approach showed better short-term right ventricular (RV) function after left ventricular assist device (LVAD) implantation. However, long-term survival and adverse event rates were similar between LT and sternotomy.

Keywords:
EchocardiographyLateral thoracotomyLeft ventricular assist deviceRight ventricular function

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Devices

Background:

  • Left ventricular assist device (LVAD) implantation is a critical treatment for advanced heart failure.
  • The choice of surgical approach, such as lateral thoracotomy (LT) or median sternotomy, may impact right ventricular (RV) function post-implantation.
  • Preserving RV function is crucial for patient outcomes after LVAD surgery.

Purpose of the Study:

  • To evaluate and compare the short- and long-term effects of LT versus median sternotomy on RV function following HeartMate 3 LVAD implantation.
  • To assess the impact of surgical approach on RV geometry and systolic function using echocardiography.
  • To determine if the surgical approach influences long-term outcomes, including mortality and RV failure-related events.

Main Methods:

  • A retrospective review of 195 patients who received a HeartMate 3 LVAD was conducted.
  • Patients were divided into two groups based on surgical approach: LT (n=55) and median sternotomy (n=140).
  • Echocardiographic assessments of RV function were performed pre-operatively, at 1 month, and at 1 year post-implantation. Primary outcome was all-cause mortality; secondary outcome was a composite of death or RV failure readmission.

Main Results:

  • No significant differences in preoperative RV geometry or function were observed between the LT and sternotomy groups.
  • One month post-LVAD implantation, the LT group demonstrated significantly better RV function, evidenced by smaller RV dimensions and improved fractional area change and peak systolic velocity.
  • Despite improved short-term RV function with LT, Kaplan-Meier analysis showed no significant differences in 2-year survival (93% vs. 83%) or adverse event rates (76% vs. 71%) between the two surgical approaches.

Conclusions:

  • The lateral thoracotomy approach is associated with better preserved right ventricular function at one month after left ventricular assist device implantation.
  • However, this short-term functional benefit does not translate into significant differences in long-term survival or adverse event rates compared to the median sternotomy approach.
  • The findings suggest that while LT may offer advantages in early RV recovery, the overall clinical impact on long-term outcomes needs further investigation.