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Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
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Related Experiment Video

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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
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Extracorporeal biventricular support through left mini-thoracotomy.

Maria Yamamoto1, Shin Yajima2, Takuji Kawamura1

  • 1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.

Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs
|November 14, 2025
PubMed
Summary

This case study highlights a novel approach to biventricular assist device surgery, preserving the sternum through a left mini-thoracotomy. This technique offers advantages for patients with complex cardiac conditions requiring mechanical circulatory support.

Keywords:
Extracorporeal biventricular supportMechanical circulatory supportMinimally invasive cardiac surgeryMinithoracotomyVentricular assist device

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Mechanical Circulatory Support

Background:

  • Fulminant myocarditis can lead to severe biventricular failure and cardiogenic shock.
  • Standard mechanical support strategies may not be sufficient for recovery in all cases.
  • Complex aortic anatomy can pose challenges for device implantation.

Purpose of the Study:

  • To present a case of severe biventricular failure refractory to conventional support.
  • To describe a minimally invasive surgical approach for extracorporeal biventricular assist device (BiVAD) implantation.
  • To evaluate the feasibility of sternum-preserving BiVAD surgery in a patient with a leftward ascending aorta.

Main Methods:

  • A 23-year-old female patient with fulminant myocarditis and biventricular failure was managed with escalating mechanical support.
  • Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella CP were initially used, followed by an upgrade to an extracorporeal left ventricular assist device (ELVAD).
  • A left mini-thoracotomy approach was employed for the implantation of an extracorporeal BiVAD, with subsequent sternotomy for durable device implantation.

Main Results:

  • The patient experienced persistent right heart failure despite initial mechanical support.
  • A left mini-thoracotomy allowed for BiVAD implantation, avoiding sternal division and facilitating access to the ascending aorta.
  • A large aortic thrombus was successfully removed during the procedure.
  • The patient ultimately received durable left ventricular assist device (LVAD) implantation with concurrent extracorporeal right ventricular assist device (RVAD) support.

Conclusions:

  • Extracorporeal BiVAD surgery via left mini-thoracotomy is a viable option for selected patients with complex cardiac conditions.
  • Sternum preservation may reduce adhesions and simplify future surgical interventions.
  • This approach offers an alternative for patients with challenging anatomy or when future sternotomy is anticipated.