Outcomes of Sternal-Sparing Left Ventricular Assist Device Insertion in Obese Patients

Sternal-sparing left ventricular assist device (ssLVAD) insertion avoids the morbidity of median sternotomy for patients with heart failure. Obesity may present challenges in this minimal access operation. We present our experience with ssLVAD in patients with body mass index (BMI) of > 35 kg/m² or greater.

A single-center retrospective review of durable ssLVADs implanted from 2019 to 2024 was performed. Patients were stratified by the presence of World Health Organization obesity grade II (BMI >35 kg/m²). A composite outcome was created, including the presence of postoperative right ventricular failure, death from any cause, or stroke.

A total of 83 patients were identified during the study period, 28 (33.7%) with a BMI greater than 35 kg/m². Obese patients experienced longer overall operative time (6.38 versus 5.57 h, P= 0.005) and trended toward longer cardiopulmonary bypass times (132 versus 114 min, P= 0.06) than nonobese patients. There were no differences in rates of intraoperative blood transfusions, postoperative intensive care unit time, ventilator time, or postoperative complications. Thirty-day survival among all recipients was 100%. There were no statistical differences in incidence of the composite outcome among patients with BMI >35 (36%) versus BMI <35 (64%) (P= 0.7).

In obese patients, although ssLVAD may be more technically challenging and appeared to be associated with increased overall operative time compared to the median sternotomy approach, this did not affect recipient outcomes. Sternal-sparing LVAD is a safe surgical option in World Health Organization class II obese patients with the added benefit of avoiding median sternotomy.