Background: Despite improved survival and morbidity after durable left ventricular assist device (dLVAD), outcomes for cardiogenic shock patients are suboptimal. Temporary mechanical circulatory support (tMCS) can permit optimization prior to dLVAD. Excellent outcomes have been observed using minimally-invasive dLVAD implantation. However, some feel tMCS contraindicates this approach. To evaluate whether left thoracotomy/hemisternotomy (LTHS) dLVAD placement is safe in this setting, we compared patients who did and did not require tMCS. Methods: Outcomes for patients receiving dLVADs via LTHS were compared among those bridged with ECMO, IABP, or no tMCS. We evaluated demographics, comorbidities, laboratory and hemodynamic data, and intra- and postoperative outcomes. Results: Eighty-three patients underwent LTHS dLVAD placement. Fifty did not require tMCS, while 22 (26%) required IABP, and 11 (13%) ECMO. Non-tMCS patients were primarily INTERMACS 3 (56%), while IABP recipients were mainly INTERMACS 2 (45%). All ECMO patients were INTERMACS 1. Patients with tMCS had worse end-organ function. Operative outcomes were similar except more concomitant procedures and red-cell transfusions in ECMO patients. ICU and hospital length of stay and inotrope duration were also similar. There were no differences in bleeding, stroke, and infection rates. Three- and twelve-month survival were: No tMCS: 94%, 86%; IABP: 100%, 88%; ECMO: 81%, 81% (p=0.45). Conclusions: Patients with cardiogenic shock can safely undergo LTHS dLVAD implantation after stabilization with ECMO or IABP. Outcomes and complications in these patients were comparable to a less severely ill cohort without tMCS.
