Minimal-access left ventricular assist device implantation.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Mechanical Circulatory Support

Background:

• Left ventricular assist device (LVAD) implantation traditionally involves a full sternotomy and cardiopulmonary bypass (CPB).
• Minimally invasive surgery (MIS) aims to reduce surgical trauma through smaller incisions and potentially shorter CPB times.

Purpose of the Study:

• To evaluate the feasibility and outcomes of minimally invasive surgery (MIS) for left ventricular assist device (LVAD) implantation.
• To compare MIS LVAD implantation with the traditional sternotomy approach.

Main Methods:

• Retrospective review of 42 LVAD implantations, comparing 25 MIS procedures with 17 sternotomy procedures.
• MIS approach varied by device: three incisions for HeartMate II, two for HeartWare.
• Four HeartWare devices were implanted off-pump, three via MIS.

Main Results:

• Minimally invasive surgery (MIS) LVAD patients experienced significantly shorter cardiopulmonary bypass (CPB) times (51.4 vs. 83.6 minutes, P=0.014).
• A trend towards lower red blood cell and platelet transfusion requirements was observed in the MIS group.
• Overall survival was 81% at mean follow-up of 495 days; 30-day mortality was 9.5%.

Conclusions:

• Minimally invasive surgery (MIS) is a feasible approach for left ventricular assist device (LVAD) implantation.
• Shorter CPB duration and potential off-pump implantation in MIS may offer advantages.
• Avoiding sternotomy in LVAD procedures may reduce adhesions for subsequent cardiac transplantation.