From Wide Open Spaces to Tiny Robot Holes: Single-Center Comparison of Implant Techniques for Left Ventricular Assist Device (LVAD) Implantation

Abstract

Purpose Current studies are just beginning to reveal possible benefits of thoracotomy for LVAD implant but most have not included both durable device types or additional techniques such as robotic assistance. This review serves to evaluate our initial single-center experience with LVAD implant via thoracotomy (with both hemisternotomy and robotic assistance). Methods Primary sternotomy, reop sternotomy, thoracotomy with hemisternotomy, and robotic assisted thoracotomy implants of HeartWare and HeartMate 3 LVADs 2018-2020 were evaluated. Narcotic use, cost, outflow graft position, operative data, and mortality were compiled and t-test performed between primary sternotomy and other groups on selected data. Results All patients were alive or transplanted at 6 months post-implant. Compared to primary sternotomy, reop sternotomy and robot assisted thoracotomy had longer bypass times and robot assisted thoracotomy had less red blood cell and FFP use. Outflow graft position with robotic assist was consistently away from the sternum (Fig 1). Conclusion There were no significant differences between mortality and narcotic use between primary sternotomy, reop sternotomy, and thoracotomy LVAD implants. Despite the cost of robotic disposable equipment, overall cost was not significantly different. Lower blood product usage and more preferable outflow graft position with robotic assist may result in fewer antibodies and easier reentry for transplant. A multi-center data review should be undertaken to capitalize on gains as we continue to advance non-sternotomy approach.