Complete Sternal-Sparing LVAD Implantation Improves Mobility Compared to Full Sternotomy

Purpose Left ventricular assist device (LVAD) implantation via a complete sternal-sparing (CSS) technique is gaining interest due to several associated benefits. We hypothesized that the CSS approach for HeartMate 3 LVAD implantation improves postoperative mobility and physical independence compared to full sternotomy (FS). Methods We retrospectively reviewed all patients implanted with a commercial HeartMate 3 at our institution from September 2017 to August 2018 (N=52). Patients were grouped based on surgical technique, CSS or FS. Patients were excluded if they did not see a physical therapist within three weeks postoperatively. The Activity Measure for Post Acute Care (AM-PAC) short forms and Functional Independence Measure (FIM) scores were used to assess postoperative mobility and physical limitations. Results A total of 43 patients were included in the study; 27 (63%) were implanted via the CSS approach and 16 (37%) underwent FS. Preoperative characteristics were similar between cohorts. By postoperative day 3 (POD3), the CSS cohort demonstrated improved mobility based on AM-PAC scores compared to the FS group (Figure 1) with 40% of the CSS cohort versus 67% of the FS cohort remaining 100% impaired. The CSS cohort also demonstrated greater postoperative independence in the FIM sit-to-stand metric (Figure 2) with 78% of the CSS cohort achieving modified or complete independence by POD15 compared to 21% of the FS patients. Conclusion The CSS approach for HeartMate 3 LVAD implantation improves postoperative mobility and functional independence compared to FS.