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Median Sternotomy or Right Thoracotomy Techniques for Total Artificial Heart Implantation in Calves
Jamshid H Karimov1, Nader Moazami2,3, Gengo Sunagawa2
1Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA. karimoj@ccf.org.
Insights
Median sternotomy and lateral thoracotomy are viable surgical approaches for Cleveland Clinic continuous-flow total artificial heart (CFTAH) implantation. Full median sternotomy offers superior visualization for anastomoses and hemostasis after device connection.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Optimal operative access is crucial for successful mechanical circulatory support device implantation.
- The Cleveland Clinic continuous-flow total artificial heart (CFTAH) is a device requiring precise surgical placement.
Purpose of the Study:
- To retrospectively compare median sternotomy and lateral thoracotomy for CFTAH implantation in a bovine model.
- To evaluate the impact of surgical approach on visualization and postoperative outcomes.
Main Methods:
- Retrospective evaluation of 17 calves implanted with CFTAH via median sternotomy (n=9) or right thoracotomy (n=8).
- Standardized surgical techniques and postoperative care were applied for elective chronic implantation (14, 30, or 90 days).
Main Results:
- Both median sternotomy and right thoracotomy provided excellent initial surgical field visualization.
- Median sternotomy offered superior visualization of anastomoses and facilitated hemostasis confirmation and repair due to easier device manipulation.
- Full median sternotomy provided larger viewing angles at the anastomotic suture line post-device connection.
Conclusions:
- Both surgical approaches are feasible for CFTAH implantation.
- Median sternotomy is advantageous for visualizing anastomoses and ensuring hemostasis, particularly after device connection.
Abstract:
The choice of optimal operative access technique for mechanical circulatory support device implantation ensures successful postoperative outcomes. In this study, we retrospectively evaluated the median sternotomy and lateral thoracotomy incisions for placement of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) in a bovine model. The CFTAH was implanted in 17 calves (Jersey calves; weight range, 77.0-93.9 kg) through a median sternotomy (n = 9) or right thoracotomy (n = 8) for elective chronic implantation periods of 14, 30, or 90 days. Similar preoperative preparation, surgical techniques, and postoperative care were employed. Implantation of the CFTAH was successfully performed in all cases. Both methods provided excellent surgical field visualization. After device connection, however, the median sternotomy approach provided better visualization of the anastomoses and surgical lines for hemostasis confirmation and repair due to easier device displacement, which is severely limited following right thoracotomy. All four animals sacrificed after completion of the planned durations (up to 90 days) were operated through full median sternotomy. Our data demonstrate that both approaches provide excellent initial field visualization. Full median sternotomy provides larger viewing angles at the anastomotic suture line after device connection to inflow and outflow ports.
