Minimally invasive surgical Jarvik 2000 off-pump implantation

Therapy with mechanical ventricular assist devices (VADs) in severe heart failure, open to discussion decades ago, is now well established for temporary or long-term support. The typical VAD candidate is very compromised and may not have sufficient resources to tolerate major surgical insults and trauma. Therefore, device implantation through smaller, less traumatic incisions is a desirable goal. The median sternotomy decreases lung volumes and reduces thoracic motion with a significant decrease in functional residual capacity and total lung capacity months later. Minimally invasive cardiac surgery was devised to reduce morbidity because of its potentially less inflammatory response, reduced transfusion requirements and minimal scarring with consequent rapid rehabilitation to normal life activity. Additionally, avoiding cardiopulmonary circulatory support (CPB) even for a short period might reduce the release of inflammatory cytokines and their consequences, as most CPB-related damage happens within the first few minutes. We describe the tricks and traps of minimally invasive approach during VAD implantation, by associating mini-anterior left thoracotomy in the fifth intercostal space with a mini-anterior right thoracotomy in the second intercostal space, without the aid of CPB in paravertebral block regional analgesia combined with mild general anasthesia.