Perioperative outcomes and quality of life after minimally invasive versus median sternotomy left ventricular assist device implantation: a single-center retrospective cohort study.

BACKGROUND: Left ventricular assist device (LVAD) implantation is an effective destination therapy (DT) for patients ineligible for heart transplantation. While conventional median sternotomy (MS) is widely used, it involves significant surgical trauma, bleeding risk, and delayed recovery, potentially hindering rehabilitation. Minimally invasive (MI) techniques may reduce perioperative complications and enhance long-term quality of life. However, systematic comparisons between MI and MS approaches for LVAD implantation are limited, with scarce data from Chinese populations. This study compares perioperative outcomes, functional recovery, and health-related quality of life between these surgical approaches, providing high-level evidence to inform clinical practice. METHODS: This study included 18 patients who underwent LVAD implantation (MI, n=12; MS, n=6). Preoperative characteristics, intraoperative metrics, postoperative recovery parameters, and complication rates were collected and compared between the two groups. Postoperative quality of life was evaluated with a comprehensive scale integrating generic health status, disease-specific symptoms, and device-related distress. RESULTS: The MI group demonstrated superior perioperative outcomes. Intraoperative blood loss was reduced by nearly 50% (442.5±257.7 vs. 1,733.3±728.5 mL, P<0.001), and mechanical ventilation duration was shorter (5.25±4.33 vs. 27.00±27.18 days, P<0.001) compared to MS. Intensive care unit (ICU) and hospital stays were also shorter. The MI group showed improvements across multiple EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) dimensions, including overall health perception, usual activities, pain/discomfort, and body image distress (P<0.05). CONCLUSIONS: MI LVAD implantation is as safe as MS. It maintains equivalent cardiac improvement while offering faster recovery and enhanced postoperative quality of life.