Implantation of the total artificial heart by lateral thoracotomy

Progress in the techniques for surgical implantation of the artificial heart has progressed in parallel with the technology and design of the prosthesis. In the author's first experience with total artificial heart (TAH) implantation (1968) a trans-sternal split was used opening the sixth intercostal space on the right side across the sternum to the left space. This obviously was not the optimum approach but the complexity, design and size of the prosthesis required maximum exposure of the atria and great vessels. Subsequently the mid-sternal split incision was used. The Dacron fibril coated silicone rubber 8 cm Kwan-Gett ventricles implanted by the mid-sternal split sustained a calf for 14 days in 1972. A calf with the improved Jarvik 3 ventricles fabricated with the same material and implanted via mid-sternal split survived 19 days in early 1973. The surgical techniques for lateral (right) thoracotomy were adopted in this laboratory in 1973. These techniques were applicable only when the prosthesis fit better in the chest. This procedure has been adopted by other laboratories replacing the natural heart of the calf with a TAH. This report describes in detail the stepwise procedure for implantation of the total artificial heart by a lateral thoracotomy in the calf.