NYMC Faculty Publications
Reoperative Left Ventricular Assist Device Insertion Following Previous Coronary Artery Bypass Grafting: Less Invasive versus Sternotomy Approach
Author Type(s)
Faculty
DOI
10.1111/aor.14984
Journal Title
Artificial Organs
First Page
1163
Last Page
1170
Document Type
Article
Publication Date
7-1-2025
Department
Surgery
Second Department
Medicine
Keywords
coronary artery bypass grafting, left ventricular assist device, less invasive approach
Disciplines
Medicine and Health Sciences
Abstract
Purpose: Reoperative durable left ventricular assist device (LVAD) insertion after coronary artery bypass grafting (CABG) is challenging due to potential injury to bypass grafts, great vessels, or the right ventricle (RV). We sought to compare the less invasive (LI) approach to the full sternotomy (FS) technique for LVAD implantation in patients with a prior history of CABG. Methods: From March 2012 to April 2023, 29 patients with a history of CABG underwent reoperative LVAD implantation: Group FS, N = 16, and Group LI, N = 13. The LI approach includes an upper hemisternotomy and left thoracotomy without dissecting around the RV and bypass grafts. Results: The median age was 68 years in Group FS and 70 years in Group LI (p = 0.83). HeartMate II was only used in group FS (FS: 56.3% [N = 9] vs. LI: 0%), whereas HeartWare (FS: 31.3% [N = 5] vs. LI: 53.8% [N = 7]) and Heartmate 3 (FS: 12.5% [N = 2] vs. LI: 46.2% [N = 6]) were used in both groups. None of the patients experienced intraoperative injury of bypass grafts. In isolated LVAD implantation, cardiopulmonary bypass time was comparable between groups (FS: 92 [68, 96] min vs. LI: 82 [61, 96] min, p = 0.33). The incidence of severe RV failure requiring mechanical support was lower in Group LI (FS: 43.8% [N = 7] vs. LI: 0%, p = 0.02). Hospital mortality was numerically lower in the LI group (FS: 31.3% [N = 5] vs. LI: 9.1% [N = 1], p = 0.35). One-year estimated survival rates were not significantly different (FS: 68.8% ± 11.6% vs. LI: 81.8% ± 11.6%, p = 0.85). Conclusions: The less invasive technique for reoperative LVAD insertion after CABG may improve outcomes by reducing RV failure.
Recommended Citation
Kai, M., Shimamura, J., Tavolacci, S., Elgar, G., Ichikawa, H., Levine, E., Spielvogel, D., & Ohira, S. (2025). Reoperative Left Ventricular Assist Device Insertion Following Previous Coronary Artery Bypass Grafting: Less Invasive versus Sternotomy Approach. Artificial Organs, 49 (7), 1163-1170. https://doi.org/10.1111/aor.14984
