LAUSR

BACKGROUND Left ventricular assist device (LVAD) implantation via thoracotomy has many potential advantages compared to conventional sternotomy, including improved inflow cannula (IFC) positioning. We compared the difference in IFC angles, post-operative, and long-term outcomes for patients with LVADs implanted via thoracotomy and sternotomy. METHODS A single centre, retrospective analysis of 14 patients who underwent thoracotomy implantation was performed and matched with 28 patients who underwent sternotomy LVAD implantations for a total of 42 patients. Inclusion required a minimum LVAD support duration of 30 days and excluded concomitant procedures. A post-operative CT-chest was used to measure the angle the between the IFC and mitral valve in two-dimensions and results were compared with three-dimensional reconstruction using the same CT chest. Outcome data was extracted from medical records. RESULTS There was no significant difference in gender, INTERMACS score, BMI or age between the two groups. Median cardiopulmonary bypass time was longer in the thoracotomy group compared to sternotomy group, 107 minutes (86-122) vs 76 minutes (56-93), p<0.01. 3D reconstructions revealed less deviation of the IFC away from the mitral valve in devices implanted via thoracotomy compared to sternotomy, median (IQR) angle 16.3° (13.9°-21.0°) vs 23.2° (17.9°-26.4°), p<0.01. Rates of pump thrombosis, stroke and gastrointestinal bleeding were not significantly different. CONCLUSIONS Devices implanted via thoracotomy demonstrated less deviation away from mitral valve. However, there was no difference in morbidity between the two approaches. 3D reconstruction of the heart is an innovative technique to measure angulation and is clinically advantageous when compared to 2D imaging.