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.