Left ventricular assist device implantation via lateral thoracotomy: A systematic review and meta-analysis.
J Heart Lung Transplant
; 41(10): 1440-1458, 2022 10.
Article
em En
| MEDLINE
| ID: mdl-35953353
ABSTRACT
BACKGROUND:
Left ventricular assist device (LVAD) implantation via lateral thoracotomy can offer similar effectiveness to conventional approaches with less perioperative adverse events. We performed a systematic review and meta-analysis to determine the potential benefits of lateral thoracotomy (LT) for LVAD implantation compared to median sternotomy.METHODS:
We searched MEDLINE and Embase databases for studies comparing continuous-flow LVAD implantation using LT with conventional sternotomy. Main outcomes were perioperative mortality and complications.RESULTS:
Twenty-five observational studies enrolling 3072 patients were included with a median follow-up of 10 months. Perioperative mortality (30 day or in-hospital) was 7% (LT) and 14% (sternotomy); however, mortality differences were no longer statistically significant in matched/adjusted studies (RR0.86; 95%CI0.52-1.44; p = 0.58). LT was associated with decreased need for blood product transfusions (mean difference[MD] -4.7; 95%CI -7.2 to -2.3 units; p < 0.001), reoperation for bleeding (RR0.34; 95%CI0.22-0.54; p < 0.001), postoperative RVAD implantation (RR0.53; 95%CI0.36-0.77; p < 0.001), days requiring inotropes (MD -1.1; 95%CI -2.1 to -0.03 inotrope days; p = 0.04), ICU (MD -3.3; 95%CI -6.0 to -0.7 ICU days; p = 0.01), and hospital length of stay (MD -5.1; 95%CI -10.1 to -0.1 hospital days; p = 0.04) in matched/adjusted studies. Overall mortality during follow-up was significantly lower for LT in unmatched/unadjusted studies but not statistically significantly lower in matched/adjusted studies (Hazard Ratio0.82; 95%CI0.59-1.14; p = 0.24).CONCLUSION:
LVAD implantation via LT was associated with significantly decreased need for blood products, reoperation for bleeding, and postoperative RVAD implantation. Furthermore, days on inotropic support were also lower, likely contributing to the shorter length of stay. These findings support greater use of a LT approach for carefully selected patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Coração Auxiliar
/
Insuficiência Cardíaca
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
J Heart Lung Transplant
Ano de publicação:
2022
Tipo de documento:
Article