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 (RR:0.86; 95%CI:0.52-1.44; 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 (RR:0.34; 95%CI:0.22-0.54; p < 0.001), postoperative RVAD implantation (RR:0.53; 95%CI:0.36-0.77; 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 Ratio:0.82; 95%CI:0.59-1.14; 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.

中文翻译：

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经侧开胸左心室辅助装置植入：系统评价和荟萃分析

背景

通过侧开胸手术植入左心室辅助装置 (LVAD)可以提供与传统方法相似的效果，且围手术期不良事件较少。我们进行了系统回顾和荟萃分析，以确定与正中胸骨切开术相比，侧开胸术 (LT) 对 LVAD 植入的潜在益处。

方法

我们在 MEDLINE 和 Embase 数据库中搜索了比较使用 LT 与传统胸骨切开术的连续流动 LVAD 植入的研究。主要结局是围手术期死亡率和并发症。

结果

纳入 25 项观察性研究，共纳入 3072 名患者，中位随访时间为 10 个月。围手术期死亡率（30 天或住院）分别为 7%（LT）和 14%（胸骨切开术）；然而，在匹配/调整后的研究中，死亡率差异不再具有统计学意义（RR：0.86；95%CI：0.52-1.44；p  = 0.58）。LT 与输血需求减少相关（平均差 [MD]：-4.7；95%CI：-7.2 至 -2.3 单位；p < 0.001），出血再手术（RR：0.34；95%CI：0.22- 0.54；p < 0.001），术后 RVAD 植入（RR：0.53；95%CI：0.36-0.77；p < 0.001），需要正性肌力药的天数（MD：-1.1；95%CI：-2.1 至 -0.03 正性肌力药天数；p = 0.04）、ICU（MD：-3.3；95%CI：-6.0 至 -0.7 ICU 天数；p  = 0.01）和住院时间（MD：-5.1；95%CI：-10.1 至 -0.1 住院天数; p  = 0.04) 在匹配/调整研究中。在未匹配/未调整的研究中，LT 在随访期间的总死亡率显着降低，但在匹配/调整的研究中没有显着降低（风险比：0.82；95%CI：0.59-1.14；p  = 0.24）。

结论

通过 LT 植入 LVAD 与显着减少对血液制品的需求、出血再手术和术后 RVAD 植入相关。此外，正性肌力支持的天数也较低，这可能是缩短住院时间的原因。这些发现支持对精心挑选的患者更多地使用 LT 方法。