Our Summary

This research paper looks at two ways to implant a device called a left ventricular assist device (LVAD) which helps the heart pump blood. Traditionally, the device is put in through the chest bone, but more recently, doctors have been putting it in through the side of the chest, a method known as lateral thoracotomy. The research found that people who had the device put in through the side of the chest had less heart failure, bleeding, and shorter hospital stays. There was no difference in the rate of stroke between the two methods. These findings suggest that putting the device in through the side of the chest could be a better approach. However, we still don’t know what the long-term impacts of this approach might be. But based on what we know right now, it seems like it could be a better option than the traditional method.

FAQs

  1. What is a left ventricular assist device (LVAD) and how is it traditionally implanted?
  2. How does the method of lateral thoracotomy differ from the traditional method of implanting an LVAD?
  3. Based on the research, what are the potential benefits and risks of implanting the LVAD through the side of the chest?

Doctor’s Tip

A doctor might tell a patient undergoing sternotomy for a left ventricular assist device implantation that the procedure can also be done through a lateral thoracotomy, which may result in less heart failure, bleeding, and shorter hospital stays. It is important to discuss with your healthcare provider which approach may be best for you based on your individual situation.

Suitable For

Patients who are typically recommended sternotomy for the implantation of a left ventricular assist device (LVAD) include those who:

  1. Have severe heart failure and are in need of mechanical circulatory support.
  2. Have failed medical management and are not responding to other treatment options.
  3. Have a high risk of mortality without the LVAD implantation.
  4. Have a suitable anatomy for sternotomy procedure.
  5. Have a lower risk for potential complications associated with sternotomy, such as bleeding, infection, or wound healing issues.

Overall, the decision to recommend sternotomy for LVAD implantation is based on the individual patient’s specific medical condition, anatomical considerations, and risk factors. It is important for healthcare providers to carefully assess each patient’s case and determine the most appropriate approach for implanting the LVAD to ensure optimal outcomes and quality of life.

Timeline

  • Before sternotomy:
  1. Patient undergoes pre-operative evaluations including blood tests, imaging studies, and consultations with the surgical team.
  2. Patient is admitted to the hospital and prepared for surgery, which may involve fasting, medication adjustments, and marking the surgical site.
  3. Patient is taken to the operating room and given anesthesia to induce sleep and prevent pain during the procedure.
  4. Surgeon makes an incision in the chest and separates the breastbone to access the heart.
  5. Device is implanted and necessary adjustments are made to ensure proper functioning.
  6. Surgeon closes the incision with sutures or staples and the patient is taken to the recovery room for monitoring.
  • After sternotomy:
  1. Patient is closely monitored in the intensive care unit (ICU) for a period of time to ensure stability and recovery.
  2. Pain management, breathing exercises, and physical therapy may be initiated to aid in the recovery process.
  3. Patient may experience discomfort, pain, and limited mobility in the chest area.
  4. Hospital stay may vary depending on individual recovery progress and any complications that may arise.
  5. Follow-up appointments with the surgical team are scheduled to monitor healing and device function.
  6. Patient undergoes cardiac rehabilitation to regain strength and endurance.
  7. Long-term follow-up care is provided to monitor the device’s function, address any complications, and ensure overall heart health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with sternotomy compared to lateral thoracotomy for implanting a left ventricular assist device?
  2. How does the recovery process differ between sternotomy and lateral thoracotomy for this procedure?
  3. Are there any specific factors that would make me a better candidate for one method over the other?
  4. What are the long-term outcomes and success rates for patients who undergo sternotomy versus lateral thoracotomy for implanting a left ventricular assist device?
  5. How experienced are you and your team with performing the procedure using both sternotomy and lateral thoracotomy techniques?
  6. Will I have a choice in which method is used for my procedure, or is one method recommended over the other based on my individual case?
  7. How will the location of the incision affect my daily activities and quality of life post-procedure?
  8. Are there any specific precautions or restrictions I should follow after the procedure depending on which method is used?
  9. What follow-up care and monitoring will be necessary after the procedure, and will it differ based on whether sternotomy or lateral thoracotomy was performed?
  10. Are there any ongoing research studies or clinical trials investigating the long-term outcomes of patients who undergo sternotomy versus lateral thoracotomy for implanting a left ventricular assist device that I should consider participating in?

Reference

Authors: Zubair MH, Brovman EY. Journal: Curr Opin Anaesthesiol. 2023 Feb 1;36(1):25-29. doi: 10.1097/ACO.0000000000001211. Epub 2022 Nov 15. PMID: 36380572