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

Abstract

Abstract OBJECTIVES Lateral thoracotomy (LT) approach may preserve the right ventricular (RV) function after left ventricular assist device (LVAD) implantation. This study evaluated the short- and long-term RV function using echocardiography after LVAD implantation via LT or median sternotomy (sternotomy). METHODS The patients who underwent HeartMate 3 implantation were retrospectively reviewed. The RV function was assessed before and 1 month and 1 year after LVAD implantation. The primary and secondary outcomes were all-cause mortality and a composite of death or readmission due to RV failure, respectively. RESULTS Of the 195 patients, 55 (28%) underwent LT and 140 (72%) underwent sternotomy. There were no significant differences in the preoperative RV geometry or function. One month after the LVAD implantation, the LT group had a smaller RV end-diastolic dimension [42 (29–48) vs 47 (42–52) mm; P = 0.003] and RV end-diastolic area [25 (21–28) vs 29 (24–36) cm2; P < 0.001] and a greater RV fractional area change [30 (25–34)% vs 28 (23–31)%; P = 0.04] and peak systolic tissue velocity [8 (7–9) vs 7 (6–8) cm/s; P = 0.01]. Twenty-four patients died and 46 met the composite end point. Kaplan–Meier curve analysis did not reveal significant differences between LT and sternotomy in the 2-year survival (93% vs 83%; log-rank test, P = 0.28) and adverse event rate (76% vs 71%; log-rank test, P = 0.65). CONCLUSIONS LT approach yielded a better-preserved RV function at 1 month; however, there were no significant differences in the 2-year survival and adverse event rates.