Results
Between June 2018 and June 2020, 44 patients underwent LVAD
implantation. Four of these patients were undergoing device exchange and
were excluded. Of the 40 included, 17 (42.5%) devices were placed by BT
approach and 23 (57.5%) by sternotomy. The BT and sternotomy groups did
not have significant differences in median age at the time of operation
(62.0 vs. 55.0 years, p=0.274), sex (14 vs. 19 males,
p>0.99), or mean BMI (27.4 vs. 30.0, p=0.170) (Table 1).
Likewise, the groups did not demonstrate significant differences in
preoperative comorbidities or laboratory values, except for cardiac
index (2.2 vs. 1.8 liters/min/m2, p=0.020) and serum sodium (137.7 vs.
134.7 mEq/L, p=0.006) (Table 1). There was no difference in the most
recent ejection fraction prior to surgery (15.0 vs. 20.0%, p=0.460) or
in the Interagency Registry for Mechanically Assisted Circulatory
Support (INTERMACS) profile (3.0 vs. 3.0, p=0.341) (Table 1).
Furthermore, there was no difference in the percentage of patients who
required preoperative hemodynamic support in the form of inotropes,
intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation
(ECMO), with 76.5% of BT and 82.6% of sternotomy patients requiring
one or more of these modalities (p=0.702) (Table 1). Lastly, more BT
patients were planned as destination therapy (DT) than sternotomy
patients (88.2% vs. 52.2%, p=0.020) (Table 1).
In comparing postoperative outcomes, BT patients demonstrated a lower
median intraoperative blood loss than sternotomy patients (0.0 vs. 100.0
mL), though these values did not reach statistical significance
(p=0.096) (Table 2). Excluding patients who went on to receive a heart
transplant (n=8) or died (n=14), there was no difference in median
length of hospital stay after surgery (16.0 vs. 17.5 days, p=0.768). BT
patients required fewer days of postoperative inotrope support (4.0 vs.
7.0 days, p=0.012). Additionally, the mean inflow cannula angles
measured on the first postoperative chest radiograph were smaller in BT
patients (23.0 vs. 37.1 degrees, p=0.018) and had a smaller standard
deviation (13.8 vs. 20.3).