Sex differences in outcomes following less-invasive left ventricular assist device implantation

Silvia Mariani, Tong Li, Karl Bounader, Dietmar Boethig, Alexandra Schoede, Jasmin S. Hanke, Jana Michaelis, L. Christian Napp, Dominik Berliner, Guenes Dogan, Roberto Lorusso, Axel Haverich, Jan D. Schmitto*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Worse outcomes in women compared to men undergoing left ventricular assist device (LVAD) implantation remain an underestimated problem in heart failure (HF) patients. With device miniaturization, less-invasive LVAD implantation techniques have gained relevance, but their impact on outcomes in women is unknown. This study investigates sex-related differences in patients undergoing LVAD implantation through less-invasive procedures. Methods: This retrospective single-center cohort study included patients who underwent isolated LVAD implantation between 2011 and 2018 through less-invasive techniques. Propensity score matching (PSM) was utilized to balance preoperative heterogeneity. Primary endpoint was two-year survival, and secondary endpoints included long-term survival, surgical outcomes and postoperative adverse events. Results: Baseline analysis of 191 patients (females 18.3%) showed differences in terms of age [female (median, 52; IQR, 47–61); male (median, 58.5; IQR, 49–66); P=0.005], underlying diagnosis (P<0.001), INTERMACS profile (P=0.009), history of previous cardiac surgery (P=0.049) and preoperative creatinine values [female (median, 110; IQR, 71–146); male (median, 126; IQR, 9–168); P=0.049]. Over a follow-up of 460.68 patient-years, Kaplan-Meyer analysis showed better survival in females (P=0.027) and a similar probability of cardiac transplantation (P=0.288). After PSM, females showed higher needs for intraoperative fresh frozen plasma (P=0.044) and platelets (P=0.001) but comparable postoperative outcomes. No sex-related differences were noticed regarding two-year outcomes, long-term survival and adverse events. LVAD-related infections remained the most common complication with males experiencing more pump infections than women (P=0.050). Conclusions: Patients receiving less-invasive LVAD implantation do not show significant sex-related differences in short and long-term outcomes and survival. Prospective studies are needed to evaluate the role of less-invasive techniques in reducing sex-based disparities after LVAD implantation.

Original languageEnglish
Pages (from-to)255-268
Number of pages14
JournalAnnals of Cardiothoracic Surgery
Issue number2
Publication statusPublished - Mar 2021


  • Left ventricular assist device (LVAD)
  • RISK
  • lateral thoracotomy
  • minimally invasive surgery
  • sex differences
  • RACE


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