LESS INVASIVE IMPLANTATION OF THIRD GENERATION LEFT VENTRICULAR ASSIST DEVICES: PRELIMINARY ANALYSIS

Background and Aim: This study evaluates the short-term benefits of a less invasive surgical approach (LIS) compared to traditional full sternotomy (FS) for implanting third-generation left ventricular assist devices (LVADs). Methods: Out of 165 LVAD implantations at our institution, a retrospective analysis was performed on 115 centrifugal pumps recipients (HeartWare HVAD and HeartMate 3) between 2010 and 2023. Results: Of the 115 LVAD implants analyzed, 79% (n=91) were performed using FS, while 21% (n=24) used LIS. The LIS cohort was younger (median age 57 vs. 61 years, p=0.05) and more frequently received the HVAD device (83% vs. 17%, p=0.001). They presented with worse hemodynamic parameters and a higher frequency of moderate to severe tricuspid regurgitation (83.3% vs. 45.6%, p=0.001). Perioperatively, the LIS group had a lower use and shorter time of extracorporeal circulation (62% vs. 100%, p=0.001; median time 60 vs. 92.5 minutes, p=0.007), lower incidence of right heart failure (21.7% vs. 30.03%, p=0.044), and faster respiratory weaning (extubation at 48 hours, 70.8% vs. 52.7%, p=0.029). Additionally, no revision for bleeding was required (0% vs. 15.5%, p=0.014), and in-hospital mortality was lower (4.2% vs. 12.4%, p=0.003). At six months, the LIS group experienced fewer driveline infections (10.8% vs. 18.2%, p=0.05), cerebral events (4.6% vs. 6.9%, p=0.044), and pump thrombosis (0% vs. 1.4%, p=0.039). Conclusions: The less invasive surgical approach for LVAD implantation is a feasible and safe alternative to full sternotomy in selected patients.