초록접수 현황
| 21F-194 | 구연 발표 |
Clinical outcome of LVAD insertion via thoracotomy
Yang Hyun Cho, Suryeun Chung, Dong Seop Jeong, Kiick Sung, Wook Sung Kim
Department of Thoracic & Cardiovascular Surgery, Sungkyunkwan University hospital, Samsung Medical Center, Seoul, Republic of Korea
Purpose : Left ventricular assist device (LVAD) insertion via left anterior thoracotomy (lateral approach) is one of alternative of standard sternotomy approach. We reviewed our experience of lateral approach.
Methods : Between August 2012 and April 2021, 60 patients underwent implantation of centrifugal type LVAD at our institution. Surgeons decided an insertion method according to the anatomy, previous surgical history, and strategy of implantation. Outcomes of patients were compared between the left thoracotomy (LT) approach and full sternotomy (FS) approach.
Results : 11 (18%) patients of them underwent the operation via left anterior thoracotomy. 2 patients were converted from thoracotomy to sternotomy. There was no intergroup difference in baseline characteristics, except the patients in LT group were more likely to have a prior sternotomy history (63.6% vs. 18.4%, p=0.002). Early complications including ICU stay and ventilator support day were similar between the groups. The duration of inotropes support day was shorter in LT group although no statistical difference was shown (median 6 days vs. 7 days, p=0.401).
Kaplan-Meier survival analysis showed survival at 1 year was similar between the groups (79.8% in FS group and 80.8% in LT group, p= 0.331). On the cox regression analysis, INTERMACS profile 1, the presence of preoperative inotropes support within 48 hours before implantation and prior sternotomy history were associated with mortality.
Conclusion : LVAD implantation with LT showed similar clinical outcomes compared with FS approach. Role of LT approach should be reassessed in a larger cohort with meticulous adjustments.
Methods : Between August 2012 and April 2021, 60 patients underwent implantation of centrifugal type LVAD at our institution. Surgeons decided an insertion method according to the anatomy, previous surgical history, and strategy of implantation. Outcomes of patients were compared between the left thoracotomy (LT) approach and full sternotomy (FS) approach.
Results : 11 (18%) patients of them underwent the operation via left anterior thoracotomy. 2 patients were converted from thoracotomy to sternotomy. There was no intergroup difference in baseline characteristics, except the patients in LT group were more likely to have a prior sternotomy history (63.6% vs. 18.4%, p=0.002). Early complications including ICU stay and ventilator support day were similar between the groups. The duration of inotropes support day was shorter in LT group although no statistical difference was shown (median 6 days vs. 7 days, p=0.401).
Kaplan-Meier survival analysis showed survival at 1 year was similar between the groups (79.8% in FS group and 80.8% in LT group, p= 0.331). On the cox regression analysis, INTERMACS profile 1, the presence of preoperative inotropes support within 48 hours before implantation and prior sternotomy history were associated with mortality.
Conclusion : LVAD implantation with LT showed similar clinical outcomes compared with FS approach. Role of LT approach should be reassessed in a larger cohort with meticulous adjustments.
첨부파일 : LVAD thoracotomy figure.docx
책임저자: Yang hyun Cho
Department of Thoracic & Cardiovascular Surgery, Sungkyunkwan University hospital, Samsung Medical Center, Seoul, Republic of Korea
발표자: Suk kyung Lim, E-mail : skim0811@hanmail.net