Off-pump insertion of an extracorporeal LVAD through a left upper-quadrant incision

Insertion of an extracorporeal left ventricular assist device for temporary ventricular support via median sternotomy can be challenging in patients with a history of cardiac surgery, because these patients often poorly tolerate the lengthy dissection and cardiac manipulation necessary for exposure of the left ventricular apex and ascending aorta. Our approach, transdiaphragmatic left ventricular inflow cannulation with return through a graft sewn to the supraceliac aorta, can be accomplished through a left upper-quadrant abdominal incision without entering the peritoneal cavity, mediastinum, or left hemithorax. Repeated sternotomy and mediastinal dissection are thus avoided. To our knowledge, this report documents the 1st use of this technique for insertion of an extracorporeal pulsatile ventricular assist device for temporary ventricular support.