Strategic value of minimally invasive LVAD implantation in an emerging national program: A comparative cohort study
Keywords:
Left ventricular assist device; , minimally invasive surgery; , mechanical circulatory support; , thoracotomy;, postoperative morbidity; , emerging cardiac surgery programs;, resource-limited settingsAbstract
Background & Aim: Minimally invasive surgical (MIS) approaches for left ventricular assist device (LVAD) implantation have demonstrated favorable outcomes in high-volume centers. However, evidence supporting their effectiveness in emerging mechanical circulatory support (MCS) programs remains limited. This study aimed to evaluate whether minimally invasive LVAD implantation is associated with reduced postoperative morbidity compared with conventional median sternotomy within an emerging national LVAD program.
Research design and Methods: We conducted a retrospective observational cohort study including 60 consecutive adult patients who underwent durable continuous-flow LVAD implantation between 2020 and 2025 at a tertiary referral center. Patients were treated either using a minimally invasive thoracotomy-based approach (MIS, n = 30) or conventional median sternotomy (n = 30). The primary outcome was a composite postoperative morbidity endpoint, including reoperation for bleeding, right ventricular dysfunction, neurological events, acute kidney injury requiring renal replacement therapy, and clinically significant infection. Secondary outcomes included perioperative parameters, ventricular remodeling, functional recovery, and survival.
Results: Baseline demographic and clinical characteristics were comparable between groups. The MIS approach was associated with a significantly shorter cardiopulmonary bypass time (median 120 vs. 181 minutes; p = 0.028), although intraoperative blood loss was higher. The composite postoperative morbidity rate was significantly lower in the MIS group compared with sternotomy (30% vs. 50%; p = 0.04). Both surgical approaches resulted in substantial functional improvement and reverse left ventricular remodeling. One-year survival did not differ significantly between groups (log-rank p = 0.67). On multivariable analysis, MIS implantation was independently associated with a lower risk of postoperative complications (OR 0.42, 95% CI 0.18–0.96).
Conclusions: In an emerging LVAD program, minimally invasive implantation was associated with a significantly lower postoperative morbidity burden and comparable survival. These findings support the strategic adoption of minimally invasive LVAD implantation in appropriately selected patients within developing MCS programs.
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