Prior Median Sternotomy Results in Increased Mortality Following LVAD Implantation

Introduction Patients who have undergone a previous cardiovascular surgery prior to implantation of a left ventricular assist device (LVAD) is extremely common. Limited data are available as to the outcomes of these patients following LVAD implantation. We hypothesized that patients with a history of prior median sternotomy are at an increased risk of mortality following LVAD implantation. Methods All patients who underwent LVAD implantation at the University of Nebraska Medical Center between July 2005 and November 2017 underwent retrospective chart review evaluating for pre-operative risk factors and post-operative outcomes. Patients were censored at the time of heart transplantation and LVAD explantation/defunctionalization. Cox regression models were used to perform univariate and multivariate analyses. Overall survival curve was calculated using the Kaplan-Meier method and compared using the log-rank test. Results A total of 309 patients underwent LVAD implantation. The average age was 56.7 years old (12.9), 240 patients (77.7%) were male sex, 163 patients (52.8%) had a history of ischemic cardiomyopathy, and a total of 100 patients (32%) had a history of prior median sternotomy at the time of LVAD implantation. Prior median sternotomy was associated with increased mortality compared to those without prior sternotomy (Figure 1). On multivariate analysis, history of prior median sternotomy remained an independent predictor of mortality with a HR of 2.3 (95%CI 1.41-3.62, p Discussion Patients who have undergone prior median sternotomy have an increased risk of mortality following LVAD implantation. Pre-operative risk factor modification is essential in these patients to try and optimize post-operative outcomes as much as possible.