Subscribe to RSS
DOI: 10.1055/s-0038-1676841
Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation
Publication History
29 July 2018
19 November 2018
Publication Date:
08 January 2019 (online)
![](https://www.thieme-connect.de/media/thoracic/201903/lookinside/thumbnails/10-1055-s-0038-1676841_185294-1.jpg)
Abstract
Background The main purpose of this article is to investigate the impact of previous sternotomy (PS) on the outcome of three different left ventricular assist devices (LVAD).
Methods Between June 2007 and February 2018, a total of 121 patients received HeartMate II (60.3%), HeartWare (12.4%), or HeartMate III (27.3%), with or without previous sternotomy (PS and non-PS groups, respectively). Propensity matching resulted in 44 patient pairs. The primary end point was overall survival at 30 days, 1 year, 2, and 5 years, postoperatively. Secondary end points were adverse events.
Results The overall cumulative survival rates for the two study groups were significantly different (77, 63, 54, and 38% for non-PS group vs 64, 39, 27, and 24% for PS group, p = 0.036). In the PS group, there was a higher need for intraoperative implantation of short-term right ventricular assist device (22.7 vs 6.8%, p = 0.034) and a higher incidence of hepatic dysfunction (20.5 vs 4.5%, p = 0.025) and acute kidney dysfunction (40.9 vs 20.5%, p = 0.032).
Conclusion PS is a reliable predictor of mortality and morbidity after LVAD implantation.
-
References
- 1 Kirklin JK, Pagani FD, Kormos RL. , et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant 2017; 36 (10) 1080-1086
- 2 de By TMMH, Mohacsi P, Gahl B. , et al; EUROMACS members. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS): second report. Eur J Cardiothorac Surg 2017; 53 (02) 309-316
- 3 Weymann A, Farag M, Sabashnikov A. , et al; Heidelberg-Cologne-Harefield Cardiothoracic Transplantation & Mechanical Circulatory Support Outcomes Research Group. Central extracorporeal life support with left ventricular decompression to berlin heart Excor: a reliable “bridge to bridge” strategy in crash and burn patients. Artif Organs 2017; 41 (06) 519-528
- 4 O'Brien MF, Harrocks S, Clarke A, Garlick B, Barnett AG. How to do safe sternal reentry and the risk factors of redo cardiac surgery: a 21-year review with zero major cardiac injury. J Card Surg 2002; 17 (01) 4-13 http://www.ncbi.nlm.nih.gov/pubmed/12027125 [Internet]
- 5 Morales DLS, Zafar F, Arrington KA. , et al. Repeat sternotomy in congenital heart surgery: no longer a risk factor. Ann Thorac Surg 2008; 86 (03) 897-902 , discussion 897–902
- 6 Roselli EE, Pettersson GB, Blackstone EH. , et al. Adverse events during reoperative cardiac surgery: frequency, characterization, and rescue. J Thorac Cardiovasc Surg 2008; 135 (02) 316-323 , 323.e1–323.e6
- 7 Park CB, Suri RM, Burkhart HM. , et al. Identifying patients at particular risk of injury during repeat sternotomy: analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg 2010; 140 (05) 1028-1035
- 8 McCarthy PM, Smedira NG. Implantable LVAD insertion in patients with previous heart surgery. J Heart Lung Transplant 2000; 19 (8, Suppl): S95-S100
- 9 Tsiouris A, Brewer RJ, Borgi J. , et al. Is resternotomy a risk for continuous-flow left ventricular assist device outcomes?. J Card Surg 2013; 28 (01) 82-87
- 10 Papathanasiou M, Tsourelis L, Pizanis N. , et al. Resternotomy does not adversely affect outcome after left ventricular assist device implantation. Eur J Med Res 2017; 22 (01) 46 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688731/ [Internet]
- 11 INTERMACS Executive Committee. INTERMACS Adverse Event Definitions: Adult and Pediatric patients. 2013; Available from: https://www.uab.edu/medicine/intermacs/images/protocol_4.0/protocol_4.0_MoP/Appendix_ A_INTERMACS_AE_Definitions__05152013.docx
- 12 R Development Core Team. R: A Language and Environment for Statistical Computing. R Found Stat Comput Vienna Austria [Internet]. 2016;0:{ISBN} 3–900051–07–0. Available from: http://www.r-project.org/
- 13 Ho DE, Imai K, King G, Stuart EA. MatchIt: Nonparametric Preprocessing for Parametric Causal Inference. J Stat Softw 2011;42(08): ): Available from http://www.jstatsoft.org/v42/i08/ [Internet]
- 14 Zhigalov K, Mashhour A, Szczechowicz M. , et al. Clinical outcome and comparison of three different left ventricular assist devices in a high-risk cohort. Artif Organs 2018; 42 (11) 1035-1042