Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation.

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.