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Updated: Aug 15, 2025
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Comparing left ventricular assist device inflow cannula angle between median sternotomy and thoracotomy using 3D
Madeleine Pearman1,2, Sam Emmanuel1,2,3,4, Paul Jansz1,2,3,4
1St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.
Artificial Organs
|December 30, 2022
Summary
Thoracotomy implantation of left ventricular assist devices (LVADs) resulted in better inflow cannula positioning compared to sternotomy. However, both surgical approaches showed similar long-term patient outcomes and morbidity rates.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Left ventricular assist device (LVAD) implantation offers alternatives to traditional sternotomy.
- Thoracotomy approach may improve inflow cannula (IFC) positioning.
- Comparison of thoracotomy versus sternotomy for LVAD implantation is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare IFC angles, postoperative, and long-term outcomes between thoracotomy and sternotomy LVAD implantations.
- To evaluate the efficacy of 3D reconstruction in assessing IFC positioning.
- To determine if thoracotomy offers advantages in IFC alignment with the mitral valve.
Main Methods:
- Retrospective analysis of 42 patients (14 thoracotomy, 28 sternotomy) with LVAD support ≥30 days.
- Postoperative CT-chest used for 2D and 3D IFC angle measurements relative to the mitral valve.
- Matched cohort analysis excluding concomitant procedures.
Main Results:
- No significant differences in patient demographics (gender, INTERMACS score, BMI, age).
- Thoracotomy group had longer cardiopulmonary bypass times (median 107 min vs. 76 min).
- 3D reconstruction showed significantly less IFC deviation from the mitral valve in thoracotomy (16.3°) versus sternotomy (23.2°) implantations (p<0.01).
- Pump thrombosis, stroke, and GI bleeding rates were comparable between groups.
Conclusions:
- LVADs implanted via thoracotomy exhibit improved IFC alignment with the mitral valve.
- No significant difference in major morbidity was observed between thoracotomy and sternotomy approaches.
- 3D cardiac reconstruction is an innovative and clinically advantageous method for measuring IFC angulation compared to 2D imaging.
