Authors
Seda Tanyeri Üzel, Murat Karaçam, Ayhan Güneş, Barkin Kültürsay, Azmican Kaya, Süleyman Çağan Efe, Gülümser Sevgin Halil, Cem Doğan, Emre Gürcü, Mehmet Kaan Kirali, Rezzan Deniz Acar
Published in
ASAIO journal (American Society for Artificial Internal Organs : 1992). Oct 12, 2026. Epub Oct 12, 2026.
Abstract
Right ventricular (RV) dysfunction remains a critical determinant of outcomes following left ventricular assist device (LVAD) implantation. We used a doubly robust inverse probability weighting based on propensity scores to evaluate the association between surgical approach and clinical outcomes in 187 consecutive patients (thoracotomy: n = 55; sternotomy: n = 132). The primary endpoint was RV systolic function in the early postoperative period, assessed by tricuspid annular plane systolic excursion (TAPSE). Despite comparable baseline RV performance and hemodynamics, the thoracotomy-based approach was associated with superior preservation of postoperative RV systolic function compared to median sternotomy (TAPSE: 12.0 vs. 11.0 mm, p = 0.001). In weighted regression models, median sternotomy was associated with a significant reduction in postoperative TAPSE (β = -0.085, p = 0.036) and a 35% relative increase in hospital length of stay (p = 0.015). Furthermore, accounting for heart transplantation as a competing risk, median sternotomy was associated with a significantly higher hazard of long-term mortality (subdistribution hazard ratio [sHR]: 1.78, 95% confidence interval [CI]: 1.07-3.00, p = 0.027). These findings suggest that the clinical benefits of sternal-sparing techniques extend beyond acute functional protection. This surgical strategy supports the use of less invasive approaches to optimize both early recovery and long-term outcomes in the LVAD population.
PMID:
42863114
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.
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