Heart transplantation using manubrium-sparing sternotomy for sternal re-entry

Area of Science:

• Cardiovascular Surgery
• Transplantation Medicine
• Minimally Invasive Cardiac Surgery

Background:

• Minimally invasive left ventricular assist device (LVAD) insertion can complicate subsequent heart transplantation due to adhesions and altered anatomy.
• Re-entry for heart transplantation after LVAD implantation presents significant surgical challenges.
• Standard sternotomy may not provide optimal access in these complex cases.

Observation:

• A T-shaped, manubrium-sparing sternotomy technique was developed for heart transplantation.
• This approach utilizes an oscillating saw up to the first intercostal space, preserving the manubrium.
• Cardiopulmonary bypass was established using right axillary artery cannulation and percutaneous venous cannulation.
• The LVAD outflow graft was ligated and divided via a left thoracotomy.

Findings:

• The manubrium-sparing sternotomy provided excellent surgical exposure for heart transplantation.
• All anastomoses were performed using standard techniques, indicating successful graft integration.
• The described technique resulted in excellent outcomes for patients requiring re-entry after LVAD implantation.

Implications:

• This technique offers a viable solution for heart transplantation in patients with prior LVADs, potentially reducing surgical morbidity.
• Manubrium-sparing sternotomy may become a preferred approach for complex cardiac re-operations.
• Further research should evaluate long-term outcomes and compare this technique with traditional sternotomy in similar patient populations.