• Terri Sun, Paul Yen, Defen Peng, Laura Besola, Wynne Chiu, Alana Flexman, and Anson Cheung.
• Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesiology, Providence Health Care, Vancouver, BC, Canada. Electronic address: terri.sun@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Apr 27.

ObjectivesDurable left ventricular assist device (LVAD) implantation is traditionally performed via median sternotomy (MS). Less-invasive implantation may lower the incidence of postimplant right ventricular failure (RVF). Our primary objective was to determine whether less-invasive implantation reduces the odds of severe RVF compared to MS.DesignRetrospective cohort study.SettingSt. Paul's Hospital, Vancouver, BC, Canada.ParticipantsOne hundred ninety-eight adult patients between January 2008 and August 2021.InterventionsIsolated LVAD implantation either via median sternotomy or via a less-invasive surgical approach.Measurements And Main ResultsMultivariable logistic regression was used to adjust for confounders. A sensitivity analysis using inverse probability of treatment weighting analysis based on propensity scores was conducted. One hundred seventy-two patients were analyzed; 54% (94/172) underwent LVAD implantation via MS, and 45% (78/172) via less-invasive approaches. Age, sex, and comorbidities were comparable, but the MS group tended to be more critically ill prior to surgery. After adjusting for confounders, less-invasive approaches did not show significant protection against severe postimplant RVF compared to MS (adjusted odds ratio 0.53; 95% confidence interval 0.20-1.44; p = 0.21). However, patients undergoing less-invasive techniques had reduced adjusted odds of 30-day mortality (odds ratio 0.29; 95% confidence interval 0.09-0.99); p = 0.049). There was no observed benefit of less-invasive approaches over MS for major bleeding, prevention of blood product transfusion, and listing for transplantation.ConclusionsThere was no reduction in the odds of severe RVF following LVAD implantation using less-invasive approaches versus MS. However, we found improved odds of 30-day survival in the less-invasive group. The underlying mechanism requires further investigation.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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