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Minimally invasive versus conventional continuous-flow left ventricular assist device implantation for heart failure: a meta-analysis

Abstract

Many studies have reported various minimally invasive techniques for continuous-flow left ventricular assist device implantation. There is no consensus on whether minimally invasive techniques can bring more benefits for patients compared with the conventional technique, due to the limited number of patients and diverse results in current studies. Our meta-analysis mainly discussed the comparison of minimally invasive and conventional techniques. We searched controlled trials from PubMed, Cochrane Library, and Embase databases until Dec 11, 2020. Perioperative and postoperative outcomes were analyzed among 10 included studies. The protocol has been registered with PROSPERO (CRD42020221532). There were no statistical differences in the 30-day mortality (OR 0.57; 95% CI 0.29 to 1.14), 6-month mortality (OR 0.66; 95% CI 0.41 to 1.05), neurological dysfunction (OR 1.10; 95% CI 0.69 to 1.76), major infection (OR 0.68; 95% CI 0.36 to 1.28), and pump thrombus (OR 1.49; 95% CI 0.63 to 3.52) among the cohorts. Minimally invasive techniques were associated with lower incidences of major bleeding (OR 0.39; 95% CI 0.22 to 0.68), severe right heart failure (OR 0.43; 95% CI 0.23 to 0.81), and less blood-product utilization (SMD −0.44). Sensitivity analysis suggested that minimally invasive techniques were associated with a lower incidence of respiratory failure (OR 0.50; 95% CI 0.26 to 0.96) and shorter mechanical ventilation time (SMD −0.53). Subgroup analysis demonstrated that patients, implanted with a centrifugal pump by minimally invasive techniques, were associated with a shorter length of intensive care unit (ICU) stay (SMD −0.27) and hospital stay (SMD −0.42), and less blood-product utilization (SMD −0.26). In conclusion, minimally invasive techniques can reduce the risks of major bleeding, severe right heart failure, and blood-product utilization, as well as have positive impacts on reducing mechanical ventilation time and the risk of respiratory failure. Minimally invasive centrifugal pump implantation can reduce the length of ICU and hospital stay.

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Abbreviations

BMI:

Body mass index

CF-LVAD:

Continuous-flow left ventricular assist device

CPB:

Cardiopulmonary bypass

CI:

Confidence interval

CVP:

Central venous pressure

ICU:

Intensive care unit

INTERMACS:

Interagency Registry of Mechanically Assisted Circulatory Support

LVEF:

Left ventricular ejection fraction

LVAD:

Left ventricular assist device

MOOSE:

Meta-analysis of Observational Studies in Epidemiology

NA:

Not available

NOS:

Newcastle–Ottawa Scale

OR:

Odds ratio

SD:

Standard deviation

SMD:

Standardized mean difference

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Funding

This work was supported by the Natural Science Foundation of Tianjin City [18JCZDJC36200 to Zhigang Liu].

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Contributions

BZ, SG, and ZL accomplished the study design. BZ, SG, and ZL contributed to study screening. BZ, SG, and ZL extracted the data and performed the quality assessment. BZ, SG, and ZF contributed to the statistical analysis. BZ, SG, ZF, and ZL wrote and revised the manuscript. All authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis.

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Correspondence to Zhigang Liu.

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Zhang, B., Guo, S., Fu, Z. et al. Minimally invasive versus conventional continuous-flow left ventricular assist device implantation for heart failure: a meta-analysis. Heart Fail Rev 27, 1053–1061 (2022). https://doi.org/10.1007/s10741-021-10102-z

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Keywords

  • Continuous-flow left ventricular assist device
  • Minimally invasive techniques
  • The conventional technique
  • Heart failure