HeartMate 3 left ventricular assist device minimally invasive off-pump implantation

With advancements in mechanical circulatory support technology, and limitations in donor supply for heart transplantation, the use of left ventricular assist devices (LVADs) has increased significantly in recent years. Multiple studies have shown that minimally invasive cardiac surgery can improve outcomes, with shorter hospital stays, decreased morbidity, faster recovery and ambulation, and lower total hospital costs. The current generation of centrifugal continuous-flow pumps is miniaturized and makes minimally invasive approaches increasingly practicable. Lateral surgical access to the ventricle allows off-pump implantation with minimal risk of blood loss, reducing the risk of air embolism and difficult de-airing. Off-pump implantation reduces hemodilution, systemic inflammatory response syndrome due to extracorporeal circulation, and the negative effects of pulmonary hypertension and right ventricular dysfunction in the perioperative period. Minimally invasive lateral access is encouraged in cases of bridge-to-transplant to avoid the risks associated with resternotomy.  We describe the surgical technique for minimally invasive implantation of the HeartMate 3 (Abbott, USA) left ventricular assist device (LVAD), avoiding sternotomy and cardiopulmonary bypass. Our surgical approach was based on a left minithoracotomy for the LVAD implantation and a right thoracotomy for the outflow graft anastomosis to the ascending aorta.