INTRODUCTION
We previously demonstrated better inflow cannula (IFC) positioning and
less pump thrombosis with an intrapericardial centrifugal-flow LVAD
(CF-LVAD: Heartware HVAD; Medtronic, Minneapolis MN) compared to an
axial-flow device (Heartmate II; Abbott, Abbott Park,
IL)1. Since that study, our default surgical approach
for CF-LVAD insertion has evolved from conventional full sternotomy (CS)
to a less invasive lateral thoracotomy/hemi-sternotomy (LTHS)
approach2.
An advantage of LTHS is that the apical coring site can be selected and
the sewing ring placed with the heart in its natural, undeformed
position. For this reason, we hypothesized that LTHS would yield better
IFC positioning than CS. We also assessed the influence of preoperative
anatomic variables3.
Finally, we examined the effect of IFC position on left ventricle (LV)
unloading and postoperative outcomes. LV unloading was assessed by LVAD
flow index (FI = estimated LVAD flow/patient body surface area) and pre-
to post-LVAD decrement in mitral regurgitation (MR) and LV end-diastolic
dimension (LVEDD). Outcomes assessed were: pump thrombosis or embolic
stroke (PT/eCVA); freedom from 30-day and total heart failure- and
LVAD-related readmissions (HFRAs); and survival free of surgical
intervention for malposition-related LVAD dysfunction.