A safe, alternative technique for off-pump left ventricular assist device implantation in high-risk reoperative cases

The implant of a ventricular assist device is a standardized procedure. However, it carries a high-risk in reoperations, especially if there are patent by-pass grafts. An isolated thoracotomy has been previously described as an alternative access route in these patients, but it offers a limited exposure should intraoperative right-heart failure occur. In the following, we describe an alternative, off-pump technique that combines a median sternotomy with limited dissection of the right-heart with a left anterolateral thoracotomy. In our experience, it proves to be a safe way for the LVAD insertion in these high-risk patients.