Less invasive implantation of third-generation left ventricular assist devices: a single center experience

Background: This study evaluates outcomes of less invasive surgery (LIS) versus full sternotomy (FS) for left ventricular assist device (LVAD) implantation. Methods: We retrospectively analyzed 115 consecutive adult patients receiving HeartMate 3 (HM3) or HeartWare (HVAD) intrapericardial centrifugal left ventricular assist device (LVAD) implantation (2010-2023) stratified by LIS vs. FS. Primary endpoint was one-year survival; secondary endpoints included right heart failure (RHF), temporary right ventricular assist device (t-RVAD) use, rethoracotomy for bleeding, driveline infection (DLI), cerebral stroke (CS), pump thrombosis (PT), gastrointestinal bleeding (GIB), and extubation time. Results: The cohort included 24 LIS and 91 FS patients. LIS patients exhibited higher pulmonary artery pressures, pulmonary vascular resistance, and tricuspid regurgitation rate, along with lower pulmonary artery compliance index (all p < 0.05). LIS had significantly lower cardiopulmonary bypass (CPB) use (62.5% vs. 100%), and duration (60 vs. 92.5 min), and reduced blood product utilization (all p < 0.05). No cases of rethoracotomy for bleeding occurred (p = 0.037). A trend toward lower RHF and t-RVAD use was observed. Kaplan-Meier analysis revealed no significant differences in one-year survival and LVAD-related adverse events. Conclusions: LIS showed comparable outcomes to FS, representing a potential alternative for selected LVAD recipients.