Long-term pulmonary function after intrathoracic versus extrathoracic LVAD Implantation: perioperative implications at one year

BACKGROUND: Patients undergoing durable left ventricular assist device (LVAD) implantation frequently require prolonged perioperative respiratory support. However, the long-term pulmonary consequences of different surgical pump placement strategies remain unclear. We investigated longitudinal pulmonary function changes following intrathoracic versus extrathoracic LVAD implantation. METHODS: This single-center retrospective cohort study included patients who underwent LVAD implantation and completed pulmonary function testing (PFT) preoperatively and at 1 year postoperatively. Intrathoracic HeartMate 3 recipients were compared with extrathoracic HeartMate II recipients. Linear mixed-effects models assessed longitudinal changes in forced vital capacity (FVC), percent predicted FVC (%FVC), forced expiratory volume in 1 s (FEV₁), and percent predicted FEV₁ (%FEV₁), adjusting for age, sex, body surface area, and surgery era. RESULTS: Among 190 patients (intrathoracic, n = 76; extrathoracic, n = 114), greater declines in FVC, %FVC, and FEV₁ were observed at 1 year in the intrathoracic group. Significant time-by-placement interactions were identified for FVC (P = 0.010), %FVC (P = 0.010), and FEV₁ (P = 0.011), whereas %FEV₁ showed comparable trends between groups. Smaller body surface area and female sex were independently associated with lower lung volumes, whereas the apparent association with female sex was largely explained by body size. CONCLUSIONS: Intrathoracic LVAD implantation was associated with greater restrictive changes in pulmonary function at one year. These findings suggest that surgical pump positioning and patient body size may influence long-term respiratory trajectories and may be relevant for perioperative planning and postoperative follow-up.